A 40-year-old woman with hypertension, hyperlipidemia, type 2 diabetes, POTS, hypothyroidism, anxiety, and depression presented with acute left-sided weakness, tunnel vision, and new-onset headaches shortly after hospitalization for COVID-19 and Haemophilus influenzae pneumonia.

CT head showed left occipital and bilateral parietal hypodensities concerning for ischemia. CTA revealed moderate multifocal stenoses in bilateral MCA and ACA territories. MRI brain verified multifocal infarcts involving bilateral occipital, frontal, and left parietal lobes. Digital Subtraction Angiography (DSA) confirmed diffuse luminal irregularities throughout bilateral anterior and posterior circulations, consistent with vasculitis. An extensive infectious, autoimmune, and inflammatory workup, including CSF studies, was negative. A diagnosis of COVID-19-related CNS vasculitis was made. The patient was treated with high-dose corticosteroids followed by a six-week taper.

Six months later, she presented again with headaches. Repeat imaging showed chronic infarct changes without new ischemia. Repeat DSA showed complete resolution of prior multifocal vascular stenosis. She was diagnosed with post-vasculitis migraine and managed with CGRP inhibitors.