Background: While anti-Hu antibody associated encephalitis has been well-documented in association with a variety of neoplastic processes, paraneoplastic limbic encephalitis and sensory ganglionopathy with positive anti-Hu antibodies has not previously been linked in the literature with a neuroendocrine gastric tumour of advanced stage. Methods: Case report Results: We present the case of an 86-year old woman who developed behavioural changes, paroxysmal anxiety attacks and poor balance several months after being diagnosed with poorly differentiated gastric small cell tumour in a clinical setting of weight loss and anemia. Anti-Hu antibodies were present. MRI showed signal abnormalities in the right mesial temporal lobe with contrast enhancement. Paroxysmal lateralized EEG changes were recorded and EMG/NCS showed absent sensory nerve responses. Behavioural symptoms stabilized under treatment with intravenous immunoglobulins, but sensory ataxia continued to worsen. The patient declined further therapy and deceased two months after transfer to palliative care. Conclusions: To our knowledge, this is the first report linking small cell gastric tumour with limbic encephalitis, sensory ganglionopathy-associated ataxia and anti-Hu antibodies. This description further broadens the clinical spectrum of anti-Hu syndrome.