Increased Risk of Stroke After a Herpes Zoster Attack

Kang, Jiunn Horng; Ho, Jau Der; Chen, Yi Hua; Lin, Herng Ching

doi:10.1161/strokeaha.109.562017

Cited by 198 publications

(170 citation statements)

References 33 publications

(33 reference statements)

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“…Although zoster is rarely fatal, the pain associated with the acute phase of the disease and subsequent PHN significantly reduces quality of life [5]. Other rarer complications of zoster, such as cranial and peripheral nerve palsies [6], encephalitis and myelitis [7], and stroke [8,9], have been described but few data exist about the frequency and severity of these complications.…”

Section: Introductionmentioning

confidence: 99%

The Epidemiology and Prevention of Herpes Zoster

2012

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Herpes zoster is a common disease among older individuals, affecting approximately 25% of people in their lifetime and resulting in appreciable morbidity. The risk of zoster increases sharply with age and immunosuppression, yet relatively little is known about other risk factors for zoster. A vaccine for zoster is now available that holds the potential to reduce incidence of zoster and its complications. In this review, the recent literature on zoster incidence and potential risk factors for the disease are summarized. Current methods of preventing zoster and its associated morbidity are discussed, including zoster vaccine and the use of antivirals.

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Section: Introductionmentioning

confidence: 99%

The Epidemiology and Prevention of Herpes Zoster

2012

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“…Historically, VZV vasculopathy are presented with acute hemiplegia after contralateral herpes zoster opthalmicus or as arteriopathy in children with varicella [7][8][9][10]. The clinical spectrum broadens in recent years after refinement of VZV diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Herpes zoster ophthalmicus with hemiplegia due to vasculopathy

Magbri¹,

El-Magbri²,

El-Magbri³

2017

Virol Res Rev

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The patient is 68 year old white female with a history of type 2 diabetes, hypertension, hyperlipidemia, and congestive heart failure. She is functionally independent. She had chicken-pox as a child but did not received varicella zoster vaccine. In 2014 she had sudden onset of right facial throbbing headache for 2 days. Subsequently, she developed a rash of varicella zoster viral (VZV) infection in the distribution of right ophthalmic branch of the trigeminal nerve. The rash involves the tip of the nose and the patient was complaining of dizziness and impaired vision. She was seen by the ophthalmologist who put her on antiviral medication because of the threat to her vision.Two days after the appearance of the rash she complained of headache and weakness of the left side of the body. Neurological examination at that time revealed evidence of left sided stroke in the distribution of the anterior/middle cerebral arteries. A CT scan followed by MRI of the brain confirmed the presence of stroke in the distribution of the MCA at the grey-white matter junction.A spinal tap along with broader set of diagnostic laboratory tests involving VZV-IgG antibodies, CSF mononuclear pleocytosis, and positive intra-thecal synthesis of VZV-IgG as shown by dissociation of serum to CSF ratio of anti-VZV IgG confirms the diagnosis. Even through, the VZV-DNA was negative. Eventually, a diagnosis of VZVinfection (herpes zoster ophthalmicus with vasculopathy and stroke) was made.Treatment was started with prednisone 60 mg/day and tapered over 2 weeks, gabapentin 200 mg three times daily, and valacyclovir 500 mg Q12 hrs. For 14 days. The patient made a remarkable recovery with resolution of her neurological deficit, and subsidence of and eventually disappearance of the rash of VZV. Luckily, her vision was not impaired. Three months later she was in a good health, very active in her daily livings, and denied post-herpetic neuralgia (PHN). DiscussionThe advent of polymerase chain reaction (PCR) and VZV DNA sequencing along with anti-VZV antibody detection have improved clinical diagnosis of VZV infection. These advances in diagnostic technologies have made identifications of various sequelae of VZV pathology easier. The VZV-vasculopathy including, myelitis, meningoencephalitis, cerebral ataxia, and cranial polyneuritis can be diagnosed with or without VZV-rash [1].

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“…In children, up to one-third of ischaemic arteriopathies are associated with varicella 79 . In adults, the risk of stroke is increased by 30% within 1 year of zoster 80 and by 4.5-fold after zoster in the ophthalmic branch of the trigeminal nerve 81 . One large population-based analysis showed that the risk was even higher: stroke was observed within a 1-year of follow-up in 8.1% of people with zoster ophthalmicus compared with only 1.7% in a matched control group 82 .…”

Section: Neurological Complications Of Zostermentioning

confidence: 99%