Emergency Department Course: Manuel was driven to the emergency room by his parents.

Allergies: NKDA. Social History: Lives at home with his parents. Sophomore in high school. A/B student. Nonsmoker. Surgical History: None. Physical Exam: RR: 30; HR: 98; Temp: 104.2; BP: 88/60 Gen: WDWN. Lethargic. Confused and disoriented. HEENT: PERRLA, mild nystagmus. Neck: Stiff. CV: Mildly fast heart rate. No murmurs. Resp Clear. GI: Normal. Neuro: CN II-XII grossly intact; DTRs normal. Hemiparesis: Strength in right arm and leg. cjuanmonino/Vetta/Getty Images RF Failed mini-mental status exam. Emergency Department Course: Manuel was driven to the emergency room by his parents. On arrival, he appeared very confused, though not agitated. With his encephalopathic picture, we were most worried about psychotropic drug abuse or infection. A normal urine drug screen and an elevated white blood cell count were suspicious for infection. Because encephalitis and meningitis were the main concerns, we per- formed a lumbar puncture. The opening pressure was consistent with elevated intracranial pressure. The CSF showed an elevated white blood cell count. The spinal fluid culture is pending. Shortly after his lumbar puncture, Manuel had a seizure. We treated him with an anticonvulsant and the seizure stopped. The electroencephalogram findings were characteristic of herpes encephalitis. The pediatric team was called, and they admitted him to the PICU. The patient’s gate has been (lacking coordination).