Inpatient rehabilitation outcomes in patients with the new diagnosis of COVID-19 tractopathy: a case series

Study design: Retrospective Case Series. Objectives: Describe the inpatient rehabilitation outcomes of four patients with COVID-19 tractopathy. Setting: Olmsted County, Minnesota, United States of America. Methods: Retrospective review of medical records was performed to collect patient data. Results: Four individuals (n = 4, 3 men and 1 woman, mean age 58.25 years [range 56–61]) completed inpatient rehabilitation during the COVID-19 pandemic. All presented after COVID-19 infection and were admitted to acute care with progressive paraparesis. None were able to ambulate on admission to acute care. All received extensive evaluations which were largely negative except for mildly elevated CSF protein and MRI findings of longitudinally extensive T2 hyperintensity signal changes in the lateral (n = 3) and dorsal (n = 1) columns. All patients experienced incomplete spastic paraparesis. All patients experienced neurogenic bowel dysfunction; a majority experienced neuropathic pain (n = 3); half experienced impaired proprioception (n = 2); and a minority experienced neurogenic bladder dysfunction (n = 1). Between rehabilitation admission and discharge, the median improvement in lower extremity motor score was 5 (0–28). All patients were discharged home, but only one was a functional ambulator at time of discharge. Conclusion: While the underlying mechanism is yet to be elucidated, in rare cases a COVID-19 infection can lead to a tractopathy, presenting as weakness, sensory deficits, spasticity, neuropathic pain, and neurogenic bladder/bowel. Patients with COVID-19 tractopathy would benefit from inpatient rehabilitation to enhance their functional mobility and independence.