Abstract
The occurrence of a cerebrovascular event after a herpes zoster (HZ) infection represents a nightmare in clinical practice, especially in those patients with concomitant cardiovascular comorbidities/risk factors and disease related per se to a higher risk of zoster infection. Moreover, the absence of a consensus opinion regarding a specific and adequate prevention of cerebrovascular events in these patients further complicates the treatment. Accumulating evidences demonstrated that HZ and HZ ophtalmicus (HZO) increase the risk of cerebrovascular events in the short-and long-term periods. Moreover, patient’s ages < 40 years old, despite having fewer traditional cardiovascular comorbidities, demonstrated a higher risk of cerebrovascular events after both HZ and HZO infection. Further prospective studies are needed to analyse the role of antiviral treatments and vaccination in these subjects to clarify if they could be able to reduce the risk of stroke after a zoster infection. In the meanwhile, physicians must be aware of a higher risk of cerebrovascular events, especially in younger patients, with few cardiovascular risk factors, after an HZ infection.
Similar content being viewed by others
References
Arboix A (2015) Cardiovascular risk factors for acute stroke: risk profiles in the different subtypes of ischemic stroke. World J Clin Cases 3(5):418–429
Breuer J, Pacou M, Gauthier A, Brown MM (2014) Herpes zoster as a risk factor for stroke and TIA: a retrospective cohort study in the UK. Neurology. 82(3):206–212
Carvalho-Pinto BP, Faria CD (2016) Health, function and disability in stroke patients in the community. Braz J Phys Ther 20(4):355–366
Erskine N, Tran H, Levin L, Ulbricht C, Fingeroth J, Kiefe C, Goldberg RJ, Singh S (2017) A systematic review and meta-analysis on herpes zoster and the risk of cardiac and cerebrovascular events. PLoS One 12(7):e0181565
Feller L, Jadwat Y, Bouckaert M (2005) Herpes zoster post-herpetic neuralgia. SADJ. 60(10):432 436-7
Gilden D (2015) Varicella-zoster virus infections. Continuum (Minneap Minn) 21(6 Neuroinfectious Disease):1692–1703
Gnann JW Jr, Whitley RJ (2002) Clinical practice. Herpes zoster. N Engl J Med 347(5):340–346
Grose C (2018) Heightened risk of ischemic stroke after recent herpes zoster ophthalmicus. J Med Virol 90(8):1283–1284
Hosamirudsari H, Rashed P, Afsari F, Akbarpour S, Bagherzadeh A (2018) Correlation between herpes zoster and stroke—a case-control study. J Med Virol 90(8):1370–1374
Kang JH, Ho JD, Chen YH, Lin HC (2009) Increased risk of stroke after a herpes zoster attack: a population-based follow-up study. Stroke 40(11):3443–3448
Kelly-Hayes M (2010) Influence of age and health behaviors on stroke risk: lessons from longitudinal studies. J Am Geriatr Soc 58(Suppl 2):S325–S328
Khan N, Patel D, Trivedi C, Shah Y, Lichtenstein G, Lewis J, Yang YX (2018) Overall and comparative risk of herpes zoster with pharmacotherapy for inflammatory bowel diseases: a Nationwide cohort study. Clin Gastroenterol Hepatol 16:1919-1927.e3. https://doi.org/10.1016/j.cgh.2017.12.052
Kim MC, Yun SC, Lee HB, Lee PH, Lee SW, Choi SH, Kim YS, Woo JH, Kim SH, Kwon SU (2017) Herpes zoster increases the risk of stroke and myocardial infarction. J Am Coll Cardiol 70(2):295–296
Kwon SU, Yun SC, Kim MC, Kim BJ, Lee SH, Lee SO, Choi SH, Kim YS, Woo JH, Kim SH (2016) Risk of stroke and transient ischaemic attack after herpes zoster. Clin Microbiol Infect 22(6):542–548
Langan SM, Minassian C, Smeeth L, Thomas SL (2014) Risk of stroke following herpes zoster: a self-controlled case-series study. Clin Infect Dis 58(11):1497–1503
Levin MJ, Smith JG, Kaufhold RM, Barber D, Hayward AR, Chan CY, Chan IS, Li DJ, Wang W, Keller PM, Shaw A, Silber JL, Schlienger K, Chalikonda I, Vessey SJ, Caulfield MJ (2003) Decline in varicella-zoster virus (VZV)-specific cell-mediated immunity with increasing age and boosting with a high-dose VZV vaccine. J Infect Dis 188(9):1336–1344
Liao CH, Chang CS, Muo CH, Kao CH (2015) High prevalence of herpes zoster in patients with depression. J Clin Psychiatry 76(9):e1099–e1104 https://doi.org/10.4088/JCP.14m09311
Liao TL, Lin CH, Chen HH, Chen YM, Lin CC, Chen DY (2017) Significant associations of neurological complications of herpes zoster with stroke in rheumatoid arthritis patients. J Am Heart Assoc 6(7) 6:pii:e006304. https://doi.org/10.1161/JAHA.117.006304
Lin HC, Chien CW, Ho JD (2010) Herpes zoster ophthalmicus and the risk of stroke: a population-based follow-up study. Neurology 74(10):792–797
Manzi S, Kuller LH, Kutzer J, Pazin GJ, Sinacore J, Medsger TA Jr, Ramsey-Goldman R (1995) Herpes zoster in systemic lupus erythematosus. J Rheumatol 22(7):1254–1258
Marinigh R, Lip GY, Fiotti N, Giansante C, Lane DA (2010) Age as a risk factor for stroke in atrial fibrillation patients: implications for thromboprophylaxis. J Am Coll Cardiol 56(11):827–837
Marra F, Ruckenstein J, Richardson K (2017) A meta-analysis of stroke risk following herpes zoster infection. BMC Infect Dis 17(1):198
Maurya PK, Kulshreshtha D, Singh AK, Thacker AK (2017 Mar) Stroke associated with varicella zoster vasculopathy: a clinicoradiological profile of 3 patients. Neurologist 22(2):64–67
Minassian C, Thomas SL, Smeeth L, Douglas I, Brauer R, Langan SM (2015) Acute cardiovascular events after herpes zoster: a self-controlled case series analysis in vaccinated and unvaccinated older residents of the United States. PLoS Med 12(12):e1001919
Muñoz-Quiles C, López-Lacort M, Díez-Domingo J (2018) Risk and impact of herpes zoster among COPD patients: a population-based study, 2009–2014. BMC Infect Dis 18(1):203
Nagel MA, Gilden D (2015) The relationship between herpes zoster and stroke. Curr Neurol Neurosci Rep 15(4):16
Nagel MA, Traktinskiy I, Azarkh Y, Kleinschmidt-DeMasters B, Hedley-Whyte T, Russman A, VanEgmond EM, Stenmark K, Frid M, Mahalingam R, Wellish M, Choe A, Cordery-Cotter R, Cohrs RJ, Gilden D (2011) Varicella zoster virus vasculopathy: analysis of virus-infected arteries. Neurology 77(4):364–370
Papagianni M, Metallidis S, Tziomalos K (2018) Herpes zoster and diabetes mellitus: a review. Diabetes Ther 9(2):545–550 https://doi.org/10.1007/s13300-018-0394-4
Pavan-Langston D, Pavan-Langston D (2008) Herpes zoster antivirals and pain management. Ophthalmology. 115(2 Suppl):S13–S20
Schink T, Behr S, Thöne K, Bricout H, Garbe E (2016 Nov 23) Risk of stroke after herpes zoster—evidence from a German self-controlled case-series study. PLoS One 11(11):e0166554
Sreenivasan N, Basit S, Wohlfahrt J, Pasternak B, Munch TN, Nielsen LP, Melbye M (2013) The short- and long-term risk of stroke after herpes zoster—a nationwide population-based cohort study. PLoS One 8(7):e69156
Sundström K, Weibull CE, Söderberg-Löfdal K, Bergström T, Sparén P, Arnheim-Dahlström L (2015) Incidence of herpes zoster and associated events including stroke—a population-based cohort study. BMC Infect Dis 15:488
Yawn BP, Wollan PC, Nagel MA, Gilden D (2016) Risk of stroke and myocardial infarction after herpes zoster in older adults in a US community population. Mayo Clin Proc 91(1):33–44
Yun H, Xie F, Delzell E, Chen L, Levitan EB, Lewis JD, Saag KG, Beukelman T, Winthrop K, Baddley JW, Curtis JR (2015) Risks of herpes zoster in patients with rheumatoid arthritis according to biologic disease-modifying therapy. Arthritis Care Res (Hoboken) 67(5):731–736
Zuin M, Rigatelli G, Picariello C, Carraro M, Zonzin P, Roncon L (2017) Prognostic role of a new risk index for the prediction of 30-day cardiovascular mortality in patients with acute pulmonary embolism: the Age-Mean Arterial Pressure Index (AMAPI). Heart Vessel 32(12):1478–1487
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Zuin, M., Rigatelli, G. & Adami, A. Cerebrovascular events after herpes zoster infection: a risk that should be not underestimated. J. Neurovirol. 25, 439–447 (2019). https://doi.org/10.1007/s13365-019-00748-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13365-019-00748-9