On admission, he was febrile, had altered mental status, osciliopsia, and
cogwheel rigidity. Magnetic resonance imaging of the brain was consistent with WNV encephalitis (4).
Karen has seen several doctors, even a neurologist at the Mayo Clinic, and after many tests, x-rays, MRI, etc., the best they could come up with was possible
cogwheel rigidity for which they had no treatment or cure.
On examination, patient was conscious, disturbed, afebrile, pulse rate-73, BP- 110/80, capillary blood glucose-80 mg/dL, SPO2- 97%, episcleritis seen, opsoclonus present, generalised lymphadenopathy (cervical/inguinal/axillary)-tender and matted, eschar in right inguinal region seen, central nervous system--emotional liability present, left upper motor neuron type of facial nerve palsy, exaggerated deep tendon reflexes, exaggerated abdominal reflex, right plantar extensor,
cogwheel rigidity and stance and gait ataxia were present.