We present a serologically proven case of WNV encephalitis in a young, pregnant woman with cranial and spinal MRI findings who was seen for asymmetric, flaccid paralysis of her extremities. Cranial MRI findings were nonspecific, as reported in reviews of West Nile virus encephalitis. Her spinal MRI displayed enhancement of the cauda equina described infrequently in the literature. Knowledge of the variable MRI appearance is important for the recognition and diagnosis of this disease.