The Neurological Exam (Encephalopathy vs. Encephalitis)

• Mental Status: Delirious. Intermittently shouting at hallucinations.
• Cranial Nerves: Pupils 3mm reactive. No facial droop.
• Motor: Increased tone (rigidity) in all four limbs. Hyperreflexia (3+) bilaterally. No hemiparesis.

Analysis: The absence of focal deficits (like hemiparesis) makes a stroke less likely (though not impossible in dengue). The generalized rigidity and hyperreflexia point towards diffuse cerebral edema or metabolic encephalopathy rather than a structural lesion.

• Meningeal Signs: Neck stiffness is equivocal (difficult to assess due to resistance). Kernig/Brudzinski negative.