We seek to study the pattern of neurovascular and autonomic findings in COVID-19-positive patients over the last two years.

Retrospective observational single-center study. Data of COVID-19-positive confirmed patients via PCR test and neurological complaints admitted from January 1^st, 2020, to December 31^st, 2022.  The study protocol was approved as exempt by Cleveland Clinic’s IRB (FLA 22-023). Neurovascular findings at presentation, risk factors, and imaging findings were studied. Autonomic data was collected from the patient’s chart who underwent evaluation at the autonomic laboratory.

57 COVID-19-positive patients were studied. 29 patients had strokes, mostly men (62%), with a mean age of 70 years. Mean BMI of 26.9kg/m². Mean NIHSS score 7, and mean length of stay was seven days (±6). 25 patients (86%) presented with ischemic strokes, nine in the posterior circulation. In the autonomic group, mean age was 46 years, mostly females (20). Postural tachycardia (POTS) in 13 patients, dizziness in 6, lightheadedness in 4, pre-syncope/syncope in 4, and paresthesia in one. No significant findings were reported in the MRI. In the autonomic group, 20% had cardiovagal failure, and 25 % had postural tachycardia (POTS) on HUT. The sudomotor index was abnormal in 32% of patients.   

Neurovascular complications following COVID-19 commonly affect elderly men, mostly with ischemic stroke. POTS was the most common autonomic presentation.