Of the 2344 total inquiries from 2/1997-2/2019, we identified 179 (8%) related to neuroinfectious diseases. The majority of inquiries related to meningitis (51%) and encephalitis (30%). One-hundred-fourteen (64%) related to management, 57 (32%) to diagnostic work-up and 43 (24%) to result interpretation. Six (4%) specifically related to results of meningitis/encephalitis pathogen polymerase chain reaction testing. Many involved specific patient populations (23% immunosuppressed, 17% children) or known exposures (7% with exposure to particular species, 7% had recent surgery/instrumentation, 6% from developing countries, 2% with recent travel abroad). Thirty-two percent of cases pertained bacteria, 23% virus, 15% fungi, 2% parasites; 28% had no pathogen identified. The most common pathogens were Cryptococcus neoformans (9%), herpes simplex virus (8%) and Borrelia burgdorferi (5%). In forty-two (23%) inquiries, patients had neurologic symptoms without a clear infectious etiology; twelve (29%) of these inquiries had non-infectious etiologies on the differential (either in the initial inquiry or responses).