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A description of 7 consecutive patients admitted for various forms of neurological impairment. All these patients were found to have cerebrospinal fluid positive for West Nile virus IgM, and routine bacterial cultures were negative. Six of these patients did not present with the typical lymphocytic pleocytosis often quoted when discussing a viral meningitis/encephalitis; rather most presented with a cerebrospinal fluid neutrophilia. (J Am Board Fam Pract 2004;17:470 -2.)doi:10.3122/jabfm.17.6.470 fatcat:exgswybvxrgdrapzexii4qttxm