The Relationship Between Herpes Zoster and Stroke
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Varicella zoster virus (VZV) infects >95 % of the world population. Typically, varicella (chickenpox) results from primary infection. The virus then becomes latent in ganglionic neurons along the entire neuraxis. In immunocompromised individuals, VZV reactivates and causes herpes zoster (shingles), pain, and rash in 1–2 dermatomes. Multiple case reports showed a link between stroke and zoster, and recent studies have emerged which reveal that VZV infection of the cerebral arteries directly causes pathological vascular remodeling and stroke (VZV vasculopathy). In the past few years, several large epidemiological studies in Taiwan, Denmark, and the U.K. demonstrated that zoster is a risk factor for stroke and that antiviral therapy may reduce this risk. Herein, the history, clinical features, and putative mechanisms of VZV vasculopathy, as well as recent epidemiological studies demonstrating that zoster increases the risk of stroke, are discussed.
KeywordsHerpes zoster Stroke Varicella zoster virus vasculopathy Vascular remodeling
The study was supported by grants from the National Institutes of Health (AG032958 and AG006127 to Dr. Gilden and NS06070 to Dr. Nagel). We thank Marina Hoffman for editorial review and Cathy Allen for manuscript preparation.
Compliance with Ethics Guidelines
Conflict of Interest
Maria A. Nagel has received the following grant: NIH/NIA PPG, Molecular Pathogenesis of VZV Infection.
Don Gilden has received the following grants: NIH/NIA PPG, Molecular Pathogenesis of VZV Infection and NIH/NINDS R01, Neurobiology of VZV.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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