Case 3:

Mrs. JN is a 65 y/o female with no medical history who presents to your clinic in mid-August with a three-day history of headache, malaise, and myalgias. She is also febrile, and she cannot walk without assistance. This is a new finding in the last 24 hours. Her husband has noted a profound deterioration in her strength and energy. She denies any recent ingestion, trauma, or sick contact. There is no reported seizure activity or focal neurological deficit.

Her physical exam is notable for a T 101F, HR 92, RR 18, BP 135/75. She has waxing and waning mental status and at times is only oriented to person. Her HEENT, lung, CV and abdominal exams are normal. Her neurological exam reveals a stiff neck and weakness in her lower extremities.