Stroke risk after varicella-zoster virus infection: a systematic review and meta-analysis

Lü, Ping; Cui, Lingyun; Zhang, Xinghu

doi:10.1007/s13365-023-01144-0

Cited by 6 publications

(4 citation statements)

References 54 publications

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“…The prognosis of most patients is better, and the frequency of continuous vascular progress is lower. 11 …”

Section: Discussionmentioning

confidence: 99%

Case Report: Isolated Vertigo as the Sole Manifestation of Left Lateral Medullary Infarction Following Contralateral Varicella-Zoster Virus Infection

Zhao,

Chang

et al. 2024

Clin Med Insights Case Rep

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Background: Cerebral infarct associated with varicella-zoster virus (VZV) has been reported in the literature, while isolated central dizziness due to lateral medullary infarct (LMI) following VZV infection is rarely reported. Case report: We report the case of a 65-year-old man who presented to the neurology department because of herpes zoster on the right trigeminal nerve distribution. At 12 hours after admission, he developed transient vertigo along with nausea and unsteady walking and left-sided spontaneous horizontal nystagmus, gaze-evoked nystagmus, and upbeat nystagmus. The other usual signs of LMI including Horner syndrome, dysarthria, swallowing difficulty, and hemibody sensory change were absent. Video head impulse indicated decreased head impulse gain of the vestibulo-ocular reflex for the bilateral horizontal, anterior, and posterior semicircular canals with abnormal saccade waves. Suppression head impulse paradigm showed few downward saccades reflecting anti-compensatory saccades after the end of the head impulse back to the head-fixed target and decreased vestibulo-ocular reflex gain values of bilateral semicircular canals. Brain magnetic resonance imaging (MRI) showed a small infarct in the far dorsolateral portion of the left rostral medulla. The cerebrospinal fluid was positive for VZV DNA. Conclusions: In patients with VZV infection who develop dizziness, the possibility of cerebral infarct should be considered. Patients with facial herpes zoster and neurological symptoms always be screened for stroke using MRI and lumbar puncture should be performed and acyclovir administered empirically.

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“…The prognosis of most patients is better, and the frequency of continuous vascular progress is lower. 11 …”

Section: Discussionmentioning

confidence: 99%

Case Report: Isolated Vertigo as the Sole Manifestation of Left Lateral Medullary Infarction Following Contralateral Varicella-Zoster Virus Infection

Zhao,

Chang

et al. 2024

Clin Med Insights Case Rep

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“…Moreover, patients with HZO had a greater likelihood of experiencing a stroke, with the middle cerebral artery being the most affected area. 18 In 2018, Harriet J. Forbes and colleagues conducted a metaanalysis to examine the correlation between the occurrence of stroke and the acquisition of herpes zoster (HZ) infection. Their findings revealed a temporary heightened susceptibility to stroke in children following a varicella infection.…”

Section: F I G U R Ementioning

confidence: 99%

“…The I 2 values (Asian: 94.29%, Non-Asian: 94.39%) analysis revealed that the region is not the source of the heterogeneity. HZ, herpes zoster; ES, effect size.Over the past decade, eight meta-analyses were conducted by Ping Lu et al, Forbes et al, Erskine et al, Zhang et al, Marra et al, Lian et al, Yang et al, and Liu et al, respectively [18][19][20][42][43][44][45][46]. Nevertheless, none of the studies overall offer a precise and consistent concept.…”

mentioning

confidence: 99%

A comprehensive, updated systematic review and meta‐analysis of epidemiologic evidence on the connection between herpes zoster infection and the risk of stroke

Heiat,

Salesi,

Peypar

et al. 2024

Reviews in Medical Virology

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Stroke is a common worldwide cause of death and disability, resulting from an obstruction or reduction in blood flow to the brain. Research has demonstrated that systemic infection such as herpes zoster (HZ) / ophthalmicus herpes zoster (HZO) can potentially trigger stroke. This study includes an updated systematic review and meta‐analysis of the epidemiologic data on the connection between HZ/HZO infection and the risk of stroke. A meticulous search of different database yielded 905 studies. Furthermore, an additional 14 studies from a previous meta‐analysis were incorporated. Eligible studies underwent rigorous screening, resulting in 18 papers. Statistical analyses, including random/fixed effects models and subgroup analyses, were conducted to assess pooled relative risk (RR) and heterogeneity. The meta‐analysis consisted of 5,505,885 participants and found a statistically significant association between HZ infection and the risk of stroke (pooled RR = 1.22, 95% confidence interval [CI] 1.12–1.34). The HZO infection showed a significantly higher overall pooled RR of 1.71 (95% CI 1.06–2.75), indicating a strong connection with the risk of stroke. Subgroup analysis revealed that the odds ratio might play a significant role in causing heterogeneity. Time since infection emerged as a crucial factor, with heightened stroke risk in the initial year post‐HZ/HZO exposure, followed by a decline after the first year. Asian/Non‐Asian studies demonstrated varied results in HZ/HZO patients. Meta‐analysis reveals a significant HZ/HZO‐stroke link. Subgroups highlight varied risks and warrant extended Asian/non‐Asian patient investigation.

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“…Besides pain, HZ is also associated with sight-threatening complications in case of trigeminal involvement, disseminated disease, neurological complications such as encephalitis, and superinfection, which could lead to hospitalization [2,7,8]. Finally, accumulating evidence also strongly indicates an association between HZ and an increased risk of stroke, up to 6 months after an HZ episode [9,10].…”

Section: Introductionmentioning

confidence: 99%

The value of herpes zoster prevention in people aging with HIV: A narrative review

Dauby,

Motet,

Libois

et al. 2023

HIV Medicine

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ObjectiveReview the evidence on the incidence and impact of herpes zoster among people living with HIV and the potential impact of recombinant zoster vaccine for people aging with HIV.MethodsNarrative review.ResultsAlthough antiretroviral therapy has substantially reduced the risk of herpes zoster among people living with HIV, they remain at an increased risk compared with the general population. Among people aging with HIV, aging per se is now the main risk factor for herpes zoster. Beyond pain, herpes zoster is also associated with a risk of sight‐threatening complications in case of trigeminal involvement, disseminated diseases and stroke. Post‐herpetic neuralgia is also a potential threat to the quality of life of people aging with HIV. The recombinant zoster vaccine has demonstrated high and sustained efficacy in the prevention of herpes zoster, post‐herpetic neuralgia, and other herpes zoster complications in the general population. Immunogenicity data among people living with HIV with high CD4+ T‐cell count and controlled viral load are comparable to those among the general population. Real‐life effectiveness data indicate high vaccine efficacy among immunocompromised patients other than people living with HIV. High vaccine price, vaccine hesitancy, and limited disease and vaccine awareness represent potential hurdles for high vaccine uptake among people aging with HIV in Europe.ConclusionsHerpes zoster, and its complications, is a vaccine‐preventable disease of aging people. Given its impact on quality of life, herpes zoster prevention using recombinant zoster vaccine is a safe strategy to be considered in every person aging with HIV.

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Stroke risk after varicella-zoster virus infection: a systematic review and meta-analysis

Cited by 6 publications

References 54 publications

Case Report: Isolated Vertigo as the Sole Manifestation of Left Lateral Medullary Infarction Following Contralateral Varicella-Zoster Virus Infection

Case Report: Isolated Vertigo as the Sole Manifestation of Left Lateral Medullary Infarction Following Contralateral Varicella-Zoster Virus Infection

A comprehensive, updated systematic review and meta‐analysis of epidemiologic evidence on the connection between herpes zoster infection and the risk of stroke

The value of herpes zoster prevention in people aging with HIV: A narrative review

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