{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T13:46:46Z","timestamp":1788961606580,"version":"build-2803163510"},"reference-count":15,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Pract Neurol"],"accepted":{"date-parts":[[2024,2,9]]},"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:p>A 30-year-old woman had 5\u2009days of visual hallucinations, nystagmus, memory impairment and mutism. On examination, she was disorientated with reduced attention span, gaze-evoked nystagmus, paratonia and abnormal frontal reflexes. Cerebrospinal fluid (CSF) showed 80 cells, protein 0.41\u2009g\/L and glucose 3.2\u2009mmol\/L (plasma glucose 5.0 mmol\/L). MR scan of the brain showed involvement of limbic and extra-limbic regions and brainstem. Commercial cell-based assays were negative, but tissue-based assays showed neuropil staining, and cell-based assays for anti-metabotropic glutamate receptor 5 (mGluR5) antibodies were positive in serum and CSF. Six months later, she was diagnosed with Hodgkin\u2019s lymphoma. This case emphasises the broader clinical spectrum of anti-mGluR5 encephalitis, challenging its initial characterisation as Ophelia syndrome. It underscores the significance of interpreting commercial cell-based assays and advocates for tissue-based assay testing followed by cell-based assay testing in serum and CSF for diagnosing rare autoimmune encephalitis.<\/jats:p>","DOI":"10.1136\/pn-2024-004089","type":"journal-article","created":{"date-parts":[[2024,2,29]],"date-time":"2024-02-29T13:20:43Z","timestamp":1709212843000},"page":"306-309","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Encephalitis associated with anti-mGluR5 antibodies"],"prefix":"10.1136","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2947-0842","authenticated-orcid":false,"given":"Denison Alves","family":"Pedrosa","sequence":"first","affiliation":[{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o Henrique Fregadolli","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rene","family":"Gleizer","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael Bernhart","family":"Carra","sequence":"additional","affiliation":[{"name":"Hospital Municipal Dr Moys\u00e9s Deutsch, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel Marin","family":"de Carvalho","sequence":"additional","affiliation":[{"name":"Hospital Municipal Dr Moys\u00e9s Deutsch, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Verena","family":"Endmayr","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Vienna, Wien, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romana","family":"Hoftberger","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Vienna, Wien, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L\u00edvia Almeida","family":"Dutra","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,2,29]]},"reference":[{"key":"2025090411005279000_24.4.306.1","doi-asserted-by":"crossref","first-page":"e1964","DOI":"10.1212\/WNL.0000000000005614","article-title":"Encephalitis with Mglur5 antibodies: symptoms and antibody effects","volume":"90","author":"Spatola","year":"2018","journal-title":"Neurology"},{"key":"2025090411005279000_24.4.306.2","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1002\/ana.26362","article-title":"Human metabotropic glutamate receptor 5 antibodies alter receptor levels and behavior in mice","volume":"92","author":"Maudes","year":"2022","journal-title":"Ann Neurol"},{"key":"2025090411005279000_24.4.306.3","doi-asserted-by":"crossref","DOI":"10.1212\/NXI.0000000000001014","article-title":"Updated diagnostic criteria for paraneoplastic neurologic syndromes","volume":"8","author":"Graus","year":"2021","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"2025090411005279000_24.4.306.4","doi-asserted-by":"crossref","first-page":"1256480","DOI":"10.3389\/fimmu.2023.1256480","article-title":"Brazilian autoimmune encephalitis network (brain): antibody profile and clinical characteristics from a multicenter study","volume":"14","author":"de Freitas Dias","year":"2023","journal-title":"Front Immunol"},{"key":"2025090411005279000_24.4.306.5","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31828ab325"},{"key":"2025090411005279000_24.4.306.6","doi-asserted-by":"crossref","DOI":"10.1002\/brb3.3003","article-title":"Anti-Metabotropic glutamate receptor 5 encephalitis: five case reports and literature review","volume":"13","author":"Chen","year":"2023","journal-title":"Brain Behav"},{"key":"2025090411005279000_24.4.306.7","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1002\/acn3.51831","article-title":"Clinical features and brain MRI volumetric changes in anti-Mglur5 encephalitis","volume":"10","author":"Sun","year":"2023","journal-title":"Ann Clin Transl Neurol"},{"key":"2025090411005279000_24.4.306.8","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1212\/WNL.0000000000000865","article-title":"Limbic encephalitis with Mglur5 antibodies and Immunotherapy-responsive prosopagnosia","volume":"83","author":"Pr\u00fcss","year":"2014","journal-title":"Neurology"},{"key":"2025090411005279000_24.4.306.9","doi-asserted-by":"crossref","unstructured":"Guevara C , Farias G , Silva-Rosas C , et al . 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