Paraneoplastic Neurological Syndromes in Ovarian Cancer: Case Report and Narrative Review for Diagnostic and Clinical Implications

Background: Paraneoplastic neurological syndromes (PNSs) are rare immune-mediated disorders associated with malignancies and may precede the diagnosis of the underlying tumor. Ovarian cancers, including both epithelial tumors and teratomas, have been associated with a spectrum of antibody-mediated neurological syndromes, although their clinical implications remain poorly defined. Objective: To describe three cases of PNS associated with ovarian malignancies and to provide a narrative review of the literature focusing on their diagnostic and clinical implications. Methods: We report three patients managed at our institution who developed paraneoplastic neurological syndromes in association with ovarian cancer. In parallel, a narrative review of the literature was conducted through PubMed and Google Scholar to identify studies published between 2020 and 2025 reporting PNS in ovarian malignancies. Relevant studies were selected and analyzed qualitatively, with emphasis on timing of onset, clinical presentation, antibody profiles, treatment strategies, and outcomes. Results: Eighteen studies were included, the majority of which were case reports. In most cases, neurological symptoms preceded the diagnosis of ovarian cancer, highlighting their potential role as an early clinical indicator of malignancy. Cerebellar degeneration was the most frequent presentation, often associated with anti-Yo antibodies, while encephalitis was more commonly linked to anti-NMDAR antibodies. Our clinical cases illustrate the heterogeneity of presentation and the complexity of diagnosis and management, requiring a multidisciplinary approach. Across studies, outcomes were variable, with partial improvement or stabilization observed in most cases following oncologic and immunomodulatory treatment. Conclusions: Paraneoplastic neurological syndromes may represent an early clinical clue to ovarian malignancy. Increased awareness among clinicians is essential to prompt appropriate diagnostic evaluation and timely oncologic management. Further research is needed to clarify the role of onconeural antibodies in early detection and disease monitoring.