In our experience, antiviral treatment has successfully normalized symptoms and inflammatory markers. cause of stroke. strong class=”kwd-title” Keywords: VZV, Vasculopathy, Stroke, Giant cell arteritis Introduction Varicella zoster computer virus (VZV) is usually a neurotropic alphaherpesvirus. Primary infection, usually in childhood, causes varicella (chickenpox), after which computer virus become latent in cranial nerve ganglia, dorsal root ganglia and autonomic ganglia along the entire neuraxis (1). As cell-mediated immunity to VZV declines with advancing age and immunosuppression, VZV reactivates to produce herpes zoster (shingles), frequently complicated by postherpetic neuralgia (radicular pain that persists long after the disappearance of rash). Zoster is also complicated by meningoencephalitis, myelitis, multiple serious ocular disorders and VZV vasculopathy. Importantly, all of the neurological and ocular complications of zoster may develop in ZPKP1 the absence of rash. Diagnosis is confirmed either by the presence of VZV DNA or anti-VZV antibodies in CSF. Rapid virological verification and prompt treatment with antiviral brokers can lead to complete recovery, even in patients with protracted disease. Overview VZV vasculopathy occurs in adults and children. Patients present with both transient ischemic attacks (TIAs) and stroke. Less often, patients present with subarachnoid or intracerebral hemorrhage secondary to ruptured aneurysm. Disease is usually often waxing and waning. Multiple cases of protracted disease that lasted for more than one year have been described. Both large and small arteries are affected. The characteristic pathology of VZV vasculopathy matches that of granulomatous arteritis. Virological analysis of intracerebral arteries of patients who died of VZV vasculopathy reveals Cowdry A inclusion bodies, multinucleated giant cells, herpes virions, VZV DNA and VZV antigen, indicating productive arterial contamination by VZV. Interestingly, VZV is the only human virus that has been shown to replicate in cerebral arteries and produce disease. Stroke after Zoster In the past few years, multiple Qstatin epidemiological studies from Taiwan, Europe, the U.K. and the U.S. have shown that the incidence of stroke after zoster is usually greater than in age-matched control patients. Analysis of Taiwanese National Health Research Institute records revealed a 30% increased risk within 1 year after zoster (2), increasing 4.5-fold with ophthalmic-distribution zoster (3). Comparable analysis of the Danish National Registry revealed a 126% increased risk of stroke within 2 weeks after zoster, a 17% increased risk Qstatin from 2 weeks to 1 1 year after zoster, and a 5% increased risk of stroke after the first year (4). Studies from the U.K. Health Improvement Network general practice database showed that not only was the risk of TIAs increased 1.15-fold, but also that myocardial infarctions (MIs) were increased 1.10-fold after zoster; and in zoster patients under 40 years of age, the risk for stroke, TIAs and MIs was significantly higher (1.74-, 2.42- and 1.49-fold, respectively) (5). A study from the U.K. Clinical Practice Research Datalink showed that the risk of stroke after zoster decreased over Qstatin time in all dermatomes, with a statistically significant age-adjusted incidence of 1 1.63 at 1C4 weeks, 1.42 at 5C12 weeks, and 1.23 at 13C26 weeks after zoster, but no decrease at later occasions (6). In patients with ophthalmic-distribution zoster, the risk of stroke was increased 3-fold at 5C12 weeks after zoster. Finally, among 55% of zoster patients who received oral antiviral therapy, the stroke risk was reduced compared to that in untreated zoster patients, indicating the value of antiviral treatment in reducing stroke incidence after zoster. More recently, a register-based cohort study in Sweden showed a 1.34-fold increased risk of stroke within 1 year after zoster in all age groups (7). As in the U.K. study, the risk of stroke in patients 39 years and younger was increased 10.3-fold within 1 year after zoster. Another U.K. study showed that the risk of stroke and MI increased 2.4- and 1.7-fold, respectively, within 2 weeks after zoster (8). Finally, in the first U.S. population-based study, the risk of stroke within 3 months of zoster was reportedly increased 1.53-fold (9). While stroke in the pediatric populace is less common, approximately one-third of arterial ischemic stroke is associated with varicella (10), with 44% of transient cerebral arteriopathy preceded by varicella (11). Together, these studies show that varicella and zoster are risk factors for stroke, particularly in individuals who develop zoster under 40 years of age, and that antiviral therapy may decrease.
