A 35-year-old man developed progressive memory problems and personality changes over the course of 6 months. This amnesia culminated in overt functional impairment as he began getting lost in familiar places and paid his rent multiple times in one day. He then displayed increased aggression and was admitted to hospital after assaulting a family member.At admission he was found to have right-sided 10th, 11th, and 12th cranial nerve palsies and left-sided supraclavicular lymphadenopathy. He was emotionally labile. Antibodies to GAD, LGI1, and Caspr2 (VGKC) and paraneoplastic antibodies, including Hu, Ri, Yo, CRMP5, Ma2, and amphiphysin, were negative. CSF 14-3-3 protein was within normal limits.Thoracic CT revealed mediastinal and right axillary lymphadenopathy. A brain MRI revealed increased T2 signal and postcontrast enhancement on T1-weighted sequences in the upper pons. An EEG showed intermittent bilateral cerebral dysfunction without asymmetry but no epileptiform abnormalities or periodic phenomena.A cervical lymph node biopsy diagnosed nodular sclerosing Hodgkin lymphoma (HL), stage IIB. After 2 cycles of treatment with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), plus dexamethasone as an antiemetic, a repeat MRI showed complete resolution of the pontine lesion. In addition, the patient had substantial improvement of all neurologic symptoms, although he could not remember the majority of his initial hospitalization. At the time of discharge following 6 cycles of ABVD, his MoCA was 27/30. A body FDG-PET approximately 8 months after admission showed a complete radiologic remission of disease. At the time of writing, the patient was living independently in the community and working full-time.After the recent publication of antibodies against metabotropic glutamate receptor 5 (mGluR5) in 2 patients with HL, 1 we examined archived CSF obtained at the time of our patient's presentation (no serum was saved), which proved to be positive for these antibodies (figure).Discussion. Paraneoplastic encephalitis (PE) in association with HL was first reported in 1982 by Carr, 2 who described an insidious neuropsychiatric degeneration in
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