A 56-year-old chef, with no prior history of movement disorders, presented to the hospital with ongoing confusion and tremors in both arms for one week. Two weeks prior to presentation, patient had a fever, vomiting and diarrhea, all of which had resolved. Neurologic examination was significant for impaired delayed recall, decreased attention, cogwheel rigidity in both arms along with a low amplitude, medium frequency resting, postural, and action tremors in both upper extremities, right greater than left. No gait abnormality was noted. Magnetic resonance imaging (MRI) of the brain was unremarkable. Cerebrospinal fluid analysis showed 31 leukocytes/mm (98% lymphocytes), a glucose level of 51 mg/dL, and a protein level of 98 mg/dL. Cerebrospinal fluid cultures for bacteria, viruses, and fungi were negative. West Nile Virus (WNV)–specific immunoglobulin (Ig) M was present on the New York State Encephalitis Panel. The patient was discharged home with supportive care. In ambulatory follow-up 3 weeks later, cognition and muscle tone were normal. Resting and action tremors had also resolved, however bilateral mild postural tremors persisted in the upper extremities, right greater than left.