Disclosures: Charles Wang, DO:

Case Diagnosis: A post COVID-19 31-year-old female with a right middle cerebral artery (MCA) subacute infarct.

Case Description: The patient presented to the emergency department with an NIH stroke scale of 12 and complaint of headache, difficulty speaking, and severe left-sided weakness. She had no significant history except for prior COVID-19 infection, which was managed on an outpatient basis. Of note, the patient was not placed on thromboprophylactic therapy after COVID-19 in accordance with current guidelines. Neurology workup revealed an evolving right MCA ischemic stroke. Transcranial Doppler was suggestive of paradoxical embolization, but subsequent transesophageal echocardiogram revealed no patent foramen ovale. Further workup was negative for pulmonary arteriovenous malformation, carotid stenosis, and coagulopathy testing was unremarkable. This cryptogenic workup indicates a high suspicion for a COVID-19 related thromboembolic event. Patient was admitted to the rehab unit 17 days later.

Setting: Inpatient Rehabilitation UnitAssessment/

Results: Despite the severity of the patient’s cerebrovascular accident (CVA), she demonstrated significant improvement though not without residual deficits. Through a 23 day course in rehab with physical, occupational, and speech therapy, both her self care and transfer CARE tool scores improved by 15 points. Her mobility scores improved from 8 upon admission to 29 at discharge, indicating significant improvement.

Discussion: This case demonstrates the need for increased vigilance and clinical suspicion for thromboembolic events in the post COVID-19 population and illustrates the limitations of current thromboprophylactic guidelines. Despite being a young patient with no apparent comorbidities and history, she experienced a CVA with initially severe deficits. Even so, the patient showed promising progress with therapy and was able to be discharged home with outpatient therapy.

Conclusion: COVID-19 presents challenges even after initial disease has subsided, most fearsome of which is coagulopathy. This poses distinct challenges for rehabilitation and further research into sequelae, prognosis, and antithrombotic therapy is needed for better CVA prevention.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/rehabilitating-a-case-of-severe-cva-in-a-young-post-covid-patient/