Covert Subclinical Neurocognitive Sequelae during the Rehabilitation Course of Severe Coronavirus Disease 2019: A Case Report.

Apart from respiratory symptoms, encephalopathy and a range of central nervous system complications have been described in COVID-19 (Coronavirus Disease 2019). However, there is a lack of published literature on the rehabilitative course and functional outcomes of severe COVID-19 with encephalopathy. Additionally, the presence of subclinical neurocognitive sequelae during post-acute rehabilitation has not been described and may be under-recognized by rehabilitation providers. We report the rehabilitative course of a middle-aged male patient with severe COVID-19 who required intensive care and mechanical ventilation. During post-acute inpatient rehabilitation for severe ICU-related weakness, an abnormal cognitive screen prompted brain MRI imaging which revealed destructive leukoencephalopathy. Subsequently, detailed psychometric evaluation revealed significant impairments in the domains of processing speed and executive function. After 40 days of intensive inpatient rehabilitation, he was discharged home with independent function. This report highlights the need for an increased awareness of covert subclinical neurocognitive sequalae, the role of comprehensive rehabilitation and value of routine cognitive screening therein; and describes the neurocognitive features in severe COVID-19.