Herpes zoster ophthalmicus and delayed contralateral hemiparesis
caused by cerebral angiitis: diagnosis and management approaches. DC
Hilt, D Buchholz, A Krumholz, H Weiss, JS Wolinsky. Ann Neurol 1983
Nov;14(5):543-553. Four patients.
Herpes zoster ophthalmicus and granulomatous angiitis. An
ill-appreciated cause of stroke. A Verghese, AM Sugar. J Am Geriatr Soc
1986 Apr;34(4):309-312. "Forty-five cases have been reported to date,
and the authors' experience with two additional cases seen in a
one-year period is described."
[Herpes zoster ophthalmicus with subsequent oculomotor paralysis and
homolateral media infarct]. B Pfeifer, K Kempkes, G Kramer. Klin
Monatsbl Augenheilkd 1989 Mar;194(3):184-186. "Since the first paper on
HZO and cerebral ischemia was published, in 1919, about 70 cases have
been described." One case.
Neurotropic herpesviruses, neural mechanisms and arteritis. JR
Martin, WJ Mitchell, DB Henken. Brain Pathol 1990 Sep;1(1):6-10. Review.
Cervical (C2) herpes zoster infection followed by pontine
infarction. JT Patrick, B Russell, J Meyer, J Biller, JL Saver. J
Neuroimaging 1995 Jul;5(3):192-193. One case.
The patterns of varicella zoster virus encephalitis. BK
Kleinschmidt-DeMasters, C Amlie-Lefond, DH Gilden. Hum Pathol 1996
Sep;27(9):927-938. All cases of VZV encephalitis at University of
Colorado Health Sciences Center since 1984.
Cerebral infarction associated with vasculitis due to varicella
zoster virus in patients infected with the human immunodeficiency
virus. O Picard, L Brunereau, B Pelosse, D Kerob, J Carbane, JC Imbert.
Biomed Pharmacother 1997;51(10):449-454. Two patients.
Mechanisms of ischaemic stroke after chickenpox. V Ganesan, FJ
Kirkham. Arch Dis Child 1997 Jun;76(6):522-525. Seven cases of ischemic
stroke in children after recent chickenpox.
Early and late manifestations of cerebral vasculitis related to
varicella zoster. MG Häusler, VT Ramakers, J Reul, R Meilicke, G
Heimann. Neuropediatrics 1998 Aug;29(4):202-207. Four children with
varicella-zoster associated cerebral vasculitis (VZCV) and stroke.
Middle cerebral arteritis and stroke after varicella in a young
adult. MC Hosseinipour, NH Smith, EP Simpson, SB Greenberg, RM
Armstrong, AC White. South Med J 1998 Nov;91(11):1070-1072. "In
Hispanic immigrants, primary varicella often appears in adolescents and
young adults. We describe the case of a 20-year-old Hispanic man with
vasculitis and stroke after primary varicella infection."
Varicella as a risk factor for cerebral infarction in childhood: a
case-control study. G Sebire, L Meyer, S Chabrier. Ann Neurol 1999
May;45(5):679-680. "The results of this case-control study show a
significant statistical link between idiopathic arterial ischemic
strokes in children and varicella-zoster virus infection."
Central nervous system and renal vasculitis associated with primary
varicella in a child. JM Caruso, GA Tung, WD Brown. Pediatrics 2001
Jan;107(1):e9. One case.
Chickenpox and stroke in childhood: a study of frequency and
causation. R Askalan, S Laughlin, S Mayank, A Chan, D MacGregor, M
Andrew, R Curtis, B Meaney, G deVeber. Stroke 2001 Jun;32(6):1257-1262.
News re Askalan: Chicken pox risk factor in childhood stroke. Anne
MacLennan. PSL Doctors Guide 2001 Jun 1. Chickenpox linked to about one
third of ischemic strokes in children. Medscape - Reuters Health news
2001 Jul 3.
The expanding specturm of herpesvirus infections of the nervous system. BK Kleinschmidt-DeMasters, DH Gilden. Brain Pathol 2001 Oct;11(4):440-451.Review. "[S]troke due to VZV-mediated large vessel disease (herpes zoster ophthalmicus) occurs predominantly in immunocompetent hosts, while small vessel disease (leukoencephalitis) and ventriculitis develop almost exclusively in immunocompromised patients."Kleinschmidt - Brain Pathol 2001 abstract / PubMed
Detection of herpesvirus genomes by polymerase chain reaction in cerebrospinal fluid and clinical findings. S Minjolle, C Arvieux, AL Gautier, I Jusselin, R Thomas, C Michelet, R Colimon. J Clin Virol 2002 Jul;25 Suppl 1:S59-70. 141 patients. "...CSF samples of immunocompetent patients contained mostly VZV (9%) and HSV-1 (7.3%)... For VZV, we report the possibility of mild, transient cerebral reactivation."Minjolle - J Clin Virol 2002 abstract / PubMed
Varicella Zoster Virus and Central Nervous System Syndromes. D
Gilden. Herpes 2004;11(suppl 2):89A-94A. Review; The International
Herpes Management Forum treatment guidelines.
The Course and Outcome of Unilateral Intracranial Arteriopathy in 79
Children With Ischaemic Stroke. KPJ Braun, MMM Bulder, S Chabrier, FJ
Kirkham; CSP Uiterwaal, M Tardieu, G Sébire. Medscape Infectious
Diseases 2009 May 29. "Stroke was preceded by chickenpox in 44% of TCA
[transient cerebral arteriopathy] patients, and in none of the patients
with progressive arteriopathies. Most infarcts were localized in the
basal ganglia... Although the arterial inflammation probably causing
TCA is 'transient', most children are left with permanent arterial
abnormalities and residual neurological deficits."
Varicella zoster virus vasculopathies: diverse clinical
manifestations, laboratory features, pathogenesis, and treatment. D
Gilden, RJ Cohrs, R Mahalingam, MA Nagel. Lancet Neurol 2009
Increased Risk of Stroke After a Herpes Zoster Attack. A
Population-Based Follow-Up Study. J-H Kang, J-D Ho, Y-H Chen, H-C Lin.
Stroke 2009 Nov;40(11):3443-3448. 133 / 7760
stroke patients (1.71%) and 306 / 23,280 randomly selected subjects
(1.31%) had herpes zoster. "The log rank test indicated that patients
with herpes zoster had significantly lower 1-year stroke-free survival
rates than the control (P<0.001). The adjusted hazard ratios of
stroke after herpes zoster and herpes zoster ophthalmicus during the
1-year follow-up period were 1.31 and 4.28, respectively."
Herpes zoster ophthalmicus and the risk of stroke: a
population-based follow-up study. HC Lin, CW Chien, JD Ho. Neurology
2010 Mar 9;74(10):792-797. 658 patients diagnosed with herpes zoster
ophthalmicus, vs 1974 controls. "Stroke developed in 8.1% of patients
with HZO and 1.7% of patients in the comparison cohort during the
1-year follow-up period. HZO patients had significantly lower 1-year
stroke-free survival rates than patients in the comparison cohort.
After adjusting for patients' demographic characteristics, selected
comorbidities, and medication habits, HZO patients were found to have a
4.52-fold (95% confidence interval 2.45-8.33) higher risk of stroke
than the matched comparison cohort. There was no significant difference
in the rate of stroke development between patients who had received
systemic antiviral treatment and those who had not."
Virus vasculopathy and stroke: an under-recognized cause and
treatment target. MA Nagel, R Mahalingam, RJ Cohrs, D Gilden. Infect
Disord Drug Targets 2010 Apr 1;10(2):105-111. Review. 37% of VZV
vasculopathy cases do not have the characteristic varicella or zoster
rash, and stroke can occur months after the rash. "The diagnostic value
of detecting anti-VZV immunoglobulin (Ig) G antibody in CSF is greater
than that of detecting VZV DNA." "VZV is the only virus for which there
is clear evidence of virus DNA and antigen in cerebral arteries
corresponding to areas of ischemia or infarction."
Thrombophilia and varicella zoster in children. M Ferrara, F Bertocco, D Ferrara, L Capozzi. Hematology 2013 Mar;18(2):119-122. 25 children with acute varicella zoster virus infection (5 with deep venous thrombosis) and 30 controls. "Coagulation disorders and [free S protein] antibody were found in children with acute VZV (groups I and II). Significant differences were shown among the three groups (P < 0.05)."Ferrara - Hematology 2013 abstract / PubMed
Herpes zoster as a risk factor for stroke and TIA: A retrospective cohort study in the UK. J Breuer, M Pacou, A Gauthier, MM Brown. Neurology 2014 Jan 21;82(3):206-212. 106,601 HZ cases and 213,202 controls. "Adjusted hazard ratios (AHRs) for TIA and MI but not stroke were increased in all patients with HZ (AHR [95% confidence interval]: 1.15 [1.09-1.21] and 1.10 [1.05-1.16], respectively). However, stroke, TIA, and MI were increased in cases whose HZ occurred when they were younger than 40 years (AHR [95% confidence interval]: 2.42 [1.34-4.36], 1.49 [1.04-2.15], and 1.74 [1.13-2.66], respectively)."Breuer - Neurology 2014 full article / PubMed Central
Central nervous system complications of varicella-zoster virus. M Science, D MacGregor, SE Richardson, S Mahant, D Tran, A Bitnun. J Pediatr 2014 Oct;165(4):779-785. 84 children admitted with VZV-associated neurological symptoms. 10 had stroke. "The time between rash onset and stroke ranged from 2 weeks to 26 weeks (median 16.0 weeks)."Science - J Pediatr 2014 abstract / PubMed
Herpes Zoster and the Risk for Stroke in Patients with Autoimmune Diseases. LH Calabrese, F Xie, H Yun, K Winthrop, JW Baddley, C Calabrese, JR Curtis. Arthritis Rheumatol 2016 Sep 2 [Epub ahead of print]. Number of patients not given in abstract. "After multivariable adjustment for multiple stroke-related factors, the incidence rate ratio (IRR) for stroke in the first 90 days after HZ was 1.36 (1.10-1.68) compared to stroke >1 year after HZ. The risk was greater for patients with zoster with cranial nerve complications (IRR 2.08, 95%CI 0.99-4.36). Prompt antiviral therapy was associated with lower incidence of subsequent stroke (IRR 0.83, 95% CI 0.70- 0.98)."Calabrese - Arthritis Rheumatol 2016 abstract / PubMed