Cerebrovascular diseases (CVD) are often associated with autonomic dysfunction. Obesity, hypertension, dyslipidemia and diabetes mellitus (or glucose intolerance) are risk factors for autonomic dysfunction. We assessed the autonomic nervous system activity (sympathetic skin response[SSR]) in patients with CVD and compared it with clinical data (body mass index, cholesterol, fasting glucose, glycated hemoglobin, blood pressure). The sympathetic skin response was evoked with electrical stimulation at rest and after cold pressor test and hyperventilation. Patients with CVD and concurrent metabolic syndrome (MetS) more often had autonomic dysfunction (namely, increased sympathetic activity and worse reaction on cold pressor test and hyperventilation) compared to patients without MetS. Increase of the amplitude of SSR correlated with high body mass index, elevated levels of total cholesterol, low-density lipoprotein, and high triglycerides, anxiety and depression. The long latency and low amplitude (autonomic neuropathy) correlated with hyperglycemia, high levels of glycated hemoglobin, and hypertriglyceridemia. Our results indicate that patients with CVD and concurrent MetS have autonomic dysfunction that is associated with obesity, dyslipidemia, anxiety and depression. The evidence of the autonomic nervous system impairment (high sympathetic activity, autonomic neuropathy) in patients with CVD may have important predictive value.