Morbidity in rubella is generally mild, and neurological complications are rare, varying from 1:6000-1:24,000. We describe an 11-year-old girl with severe manifestations of rubella encephalitis. The onset of encephalitis most often occurs within 1-6 days after development of the typical rash. Neurological features vary and include encephalitis, carotid artery thrombosis, myelitis, optic neuritis, Guillain-Barre syndrome, and peripheral neuritis. Rubella should be considered in the differential diagnosis of encephalitis despite the current vaccination program in Israel. Such cases should be prevented by encouraging widespread early childhood vaccination.