Objective: To report clinical, neuropsychological, and functional outcomes in a sample of severe cases of West Nile Virus (WNV) in acute inpatient rehabilitation. Method: Retrospective review of outcome data for 10 participants (2 females, 8 males; M age = 53 + /–12.9), who were all functionally independent prior to admission. Average acute hospitalization was 14 days (range = 3-27) while mean length of stay at inpatient rehabilitation was 17 days (range = 9-92). Assessment included neuropsychological measures (e.g., brief mental status exam, Montreal Cognitive Assessment, and/or Repeatable Battery for Assessment of Neuropsychological Status), medical data (e.g., laboratory findings, neuroimaging), and Functional Improvement Measure (FIM) scores. Results: Neuroimaging was significant for two patients, one with cortical findings and one with cortical and subcortical findings. A strong relationship was found between laboratory results (e.g., potassium, liver, kidney) and cognition at admission and FIM scores and clinical lab results (e.g., sodium, chloride, kidney, and liver function) at discharge. Neuropsychological results indicated deficits in executive functions and verbal memory which were associated with cognitive FIM scores at admit/discharge. Nine patients discharged home under care and supervision, while one patient discharged to a skilled nursing facility. Overall FIM scores improved with a mean gain of 32.3 + /− 12.9. Conclusion Patients demonstrated functional improvement at discharge, though required supervision and ongoing rehabilitation. There were consistencies with prior research, including premorbid medical history as a risk for developing neuroinvasive process, implications for kidney function, and pattern neurocognitive deficits. Results support additional studies assessing data from acute hospitalization, rehabilitation, and post-discharge to identify consistent predictive factors on outcome, recovery, and chronicity.