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Toxoplasma encephalitis — SCE Neurology MCQ

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HardCNS InfectionsToxoplasma encephalitisSCE Neurology

A young adult with Hodgkin lymphoma develops subacute amnesia, psychiatric change and seizures. MRI shows medial temporal abnormalities and CSF contains mGluR5 antibodies. Which interpretation is most appropriate?

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Correct answer: EmGluR5-associated Ophelia syndrome treated with lymphoma therapy and immunotherapy

Explanation lettering: E = shown as C · C = shown as D · D = shown as E

D is correct: mGluR5 antibody encephalitis associated with Hodgkin lymphoma is Ophelia syndrome; it is a neuronal-surface antibody disorder and can respond well to immunotherapy alongside decisive tumour treatment. A misclassifies the antibody as intracellular. B is associated with paraneoplastic cerebellar degeneration rather than limbic encephalitis. C describes LEMS. E describes a different sleep–bulbar neuroimmunological syndrome. The surface-versus-intracellular distinction predicts reversibility and treatment responsiveness.

Reference: Paraneoplastic neurological syndromes: a practical approach to diagnosis and management: https://pn.bmj.com/content/22/1/19