A 19 month old boy is brought in by his mother after an episode of twitching of his arms and legs at home. She denies any trauma or any recent history of cough, vomiting or diarrhea.

He has no past medical history. He has had all of his vaccinations.

No medicines or allergies.

Appearance:	VS Temp 40.4C HR 148 RR 28. He is sleeping comfortably. He is well nourished and well developed.
HEENT:	TM's and throat are clear. Pupils are equal and reactive to light. No signs of trauma to the head.
Lungs:	Clear bilaterally
Heart:	Regular and without murmur.
Abdomen:	soft, nontender, not distended, no HSM.
Extremities:	2+ pulses, good turgor, faint macular rash.
Neuro:	Arousable and appropriate. Moves all four limbs spontaneously.