A 15-year-old boy presents with a 12-hour history of progressive confusion, slurred speech, and ataxia. He was seen earlier in the week for rhinorrhea, cough, and fever and was diagnosed as having a viral illness. His symptoms improved until 12 hours before presentation when he became moody, confused, and ataxic. He denies any weakness, headache, diarrhea, constipation, visual changes, neck stiffness, photophobia, or phonophobia. He also denies any toxic ingestions and drug or alcohol use. He has not had any immunizations recently.
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