A 71 yo woman presented with several days of lethargy, anorexia, and weight loss had an unremarkable initial infectious and metabolic workup. One week later, she developed L>R bilateral lower extremity weakness, radiating lower back pain, acute bilateral blurry vision, and left sided hearing loss. Physical exam was notable for L>R bilateral hip flexor weakness, left knee flexion weakness, and absent left patella and Achilles reflexes. She had patchy loss of sensation to pinprick throughout the medial lower leg. MRI Brain did not show any abnormal T2 lesions. MRI of the C- and T-spine without contrast were unremarkable. MRI of the L-spine demonstrated severe left L5-S1 foraminal narrowing. A LP yielded an opening pressure of 17 cmH2O, negative basic viral studies (HSV, CMV, VZV), negative Lyme PCR, and a normal IgG index. Spinal fluid revealed only elevated protein of 113 mg/dL. EMG was consistent with bilateral lumbosacral polyradiculopathy with evidence of active denervation in bilateral lumbar paraspinal muscles and left-sided S1-innervated muscles. Ophthalmology identified punched out chorioretinal lesions on fundoscopic exam, which prompted testing for WNV. ENT evaluation was notable for bilateral SNHL on audiogram, which prompted an intra-tympanic steroid treatment. After diagnosis, WNV IgG and IgM in serum and CSF returned positive.