A 90-year-old man, who was visiting central Massachusetts, presented with new-onset right-sided weakness that was preceded by headache, voice hoarseness, and malaise of 4 weeks duration. The patient denied dyspnea, neck stiffness, or photophobia. He had a history of diabetes mellitus type 2, hypertension, and hypothyroidism. He had visited a physician during the first week of having these complaints and underwent multiple tests, including negative IgM and IgG enzyme immunoassay for Borrelia burgdorferi. Presenting physical examination demonstrated mild right upper and lower extremity weakness and disorientation to time. There was no labored breathing, use of accessory respiratory muscles, or stridor. Initial laboratory study results showed leukocytosis of 12.5 cells × 109/L with neutrophilia and no band forms. CT with angiogram of the head and neck was normal. Lumbar puncture was attempted twice without success. Empirical treatment of meningitis with IV ceftriaxone, vancomycin, and ampicillin was initiated.