Setting: Inpatient rehabilitation unit. Patient: A 58-year-old woman with a 2-month history of progressive gait ataxia, dysarthria, diplopia, and a diagnosis of cerebellar vasculitis began a course of intravenous steroids/cyclophosamide and transferred to our rehabilitation unit. Case Description: Examination on admission revealed a malar rash, truncal and appendicular ataxia, ataxic dysarthria, and emotional lability. She complained of diplopia, disabling vertigo, and refractory nausea and vomiting that worsened with activity. The nausea and vomiting responded best to the use of an eye patch, a combination of antiemetics, and initiation of therapy sessions with supine exercises. Brief rests during sessions were helpful and on day 3 her nausea improved to the point that she began to better tolerate treatment. More aggressive techniques to address her ataxia were employed as her nausea improved. Specifically, facilitation feedback techniques were used to prevent hip retraction during the stance phase and to lessen knee hyperextension. A mirror provided visual cues for coordination training and a weighted walker helped improve her gait. Her speech became more intelligible with a program that emphasized decreasing her tone and speech rate. Her biggest challenge was depression. She became profoundly depressed with passive suicidal ideation. Positive reinforcement by staff members, as well as coping strategies, counseling, and medications, were accompanied by a gradual lessening of symptoms. The patient's symptoms and function began to improve and by dismissal she no longer required antiemetics, her speech was more intelligible, and her gait had improved from total dependence to the point of ambulating more than 30m with a front-wheeled walker and the assistance of one. Assessment/Results: This is a rare case of lupus vasculits localized to the cerebellum. With the use of immune modulating medications augmented by a comprehensive rehabilitation program, the patient made great gains, reaching most goals by dismissal. Conclusions: Lupus vasculitis can involve the cerebellum and its effects causes severe impairment, which can be successfully treated with medications and a comprehensive rehabilitation program.