day discharge. The MRI result changed management in 88% of patients. Conclusion A significant proportion of patients experienced delay to discharge due to delay of inpatient MRI. The result of MRI changed treatment plans for most patients, and allowed same day discharge in almost one third of cases. Timely access to inpatient MRI is a critical and potentially modifiable variable that may reduce length of stay and expedite treatment for neurology inpatients.

had a waddling gait. Clinical picture was consistent with a clinical diagnosis of LEMS rather than myositis, which was confirmed by elevated anti-VGCC antibodies and response to Acetylcholinesterase inhibitors. Results Anti-VGCC antibodies elevated at 119pM(<30).Transiently elevated CK, negative myositis autoantibodies, negative anti-MuSK antibodies, negative AChR antibodies.Although repetitive nerve stimulation did not show increment in the right ulnar CMAP after isometric muscle activation, the clinical picture was consistent with LEMS.Marked improvement to treatment with oral prednisone and pyridostigmine. Due to side effects, pyridostigmine was changed to 3,4-Diaminopyridine therapy with excellent response.Steroids were weaned off and the patient is adequately controlled on 3,4-Diaminopyridine. Conclusion Our case report shows that LEMS can arise as a result of an immune-related adverse event (irAE) to pembrolizumab; an Anti-PD-1 Monoclonal Antibody. The immune response persists after cessation of this checkpoint inhibitor medication. It is important to recognise and treat this condition early.