COVID-19 Autonomic and Neurovascular Manifestations, a Comparison Between Two Groups: A Single Institution, 2-years Experience
Chetna Dengri1, Zarmina Javed2, Raphael Santiago3, Nestor Galvez-Jimenez4
1Neurology, Cleveland Clinic Florida, 2Neurology, Cleveland clinic florida, 3Neurosurgery, Children's Hospital Colorado, 4Cleveland Clinic - Florida
Objective:

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

Background:
Since the beginning of COVID-19, more than 7,362,046 cases have been diagnosed in Florida, with total of deaths trespassing 84,020 cases (CDC, 2023). Coronaviruses, specifically SARS-CoV, spread into the CNS by trans-neuronal or hematogenous routes. Although SARS-CoV-2 has some distinctive genetic findings, their implication in CNS invasiveness is unknown. A wide range of post-COVID-19 neurological symptoms have been described in the literature. However, limited long-term data is available to describe any specific patterns or characteristics of these post-COVID-19 neurological presentations
Design/Methods:

Retrospective observational single-center study. Data of COVID-19-positive confirmed patients via PCR test and neurological complaints admitted from January 1st, 2020, to December 31st, 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.

Results:

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.   

Conclusions:

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

10.1212/WNL.0000000000208277