Zoster Raises Risk for Stroke

Summary and Comment |
June 17, 2014

Zoster Raises Risk for Stroke

  1. Abigail Zuger, MD

Excess risk for cerebrovascular accident in zoster patients persists for 6 months then disappears.

  1. Abigail Zuger, MD

Case reports have suggested that herpes zoster acutely raises risk for cerebrovascular accident (CVA); postulated mechanisms include generalized endothelial dysfunction associated with acute infections and specific destructive effects of zoster on vascular walls. Researchers probed a clinical database of >5 million patients to characterize the association between zoster and CVA.

Among adults with new diagnoses of zoster, overall risk for both ischemic and hemorrhagic stroke rose significantly in the first month after diagnosis, slowly diminished during the following 6 months, and vanished by 1 year. The effect was mitigated by antiviral treatment: Among treated patients, risk for stroke in the first month was not significantly different from baseline and was about half that of untreated patients; stroke risk exceeded baseline only in the second and third months after diagnosis.

Both herpes zoster ophthalmicus and zoster in other trigeminal nerve branches raised stroke risk almost three times higher than zoster in other dermatomes. This risk peaked in the second and third month after diagnosis; it was somewhat attenuated by treatment but still remained significantly elevated over baseline.


Previous cohort studies have suggested similar excess risk for CVA immediately following diagnosis of zoster (and other studies hint at elevated risks for transient ischemic attack and myocardial infarction). These data provide additional evidence of the benefits of antiviral treatment during episodes of zoster and imply that the benefits of vaccination might exceed its much-advertised effects on preventing postherpetic neuralgia.

Editor Disclosures at Time of Publication

  • Disclosures for Abigail Zuger, MD at time of publication Editorial boards New York Times; Clinical Infectious Diseases


Reader Comments (1)

sreeram balachandran Physician, Internal Medicine, GOVERNMENT MEDICAL COLLEGE THRISSUR KERALA INDIA

In our hospital recently we had a patient admitted with zoster .Third day after admission patient developed head ache and vomiting .Brain imaging showed cerebral venous thrombosis.On searching literature we could find similar case reports online.

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