A 45-year-old male was brought to the emergency department because of fever, confusion, and "inability to talk." His wife reported that he had generalized malaise, headache, and low-grade fever for 3 days with no other specific symptoms. Several hours before coming, he was noted to have progressive lethargy and confusion and lost his ability to speak. He didn’t have nausea, vomiting, diarrhea nor focal weakness or seizures. He was previously in good health, took no medications, and denied recent travel. There were no recent insect bites or pet exposures.
On physical examination, his temperature was 101°F and other vital signs were normal. Expressive aphasia was noted, but there were no focal findings or nuchal rigidity and the pupils were equal and reactive to light. There were no petechiae, splinter hemorrhages, subconjunctival hemorrhages, or heart murmurs. The fundi were normal…
