Varicella Zoster Virus May Be An Underdiagnosed Cause of Stroke

The varicella virus is the cause of chickenpox. It is well established as a cause of strokes in children, in whom strokes are very rare, and also in adults with chickenpox, who are much more likely to have that and other serious complications. The virus causes a chronic infection, which reactivates in immunosuppressed persons and in the elderly, causing herpes zoster. Reactivation occurs earlier in those who had chickenpox especially early in life (<5 years old). Herpes zoster ophthalmicus (in the eye) is particularly associated with stroke.

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.

Hilt - Ann Neurol 1983 abstract / PubMed

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.

Verghese - J Am Geriatr Soc 1986 abstract / PubMed

[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.

Pfeifer - Klin Monatsbl Augenheilkd 1989 abstract / PubMed

Neurotropic herpesviruses, neural mechanisms and arteritis. JR Martin, WJ Mitchell, DB Henken. Brain Pathol 1990 Sep;1(1):6-10.

Martin - Brain Pathol 1990 abstract / PubMed

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.

Patrick - J Neuroimaging 1995 abstract / PubMed

The patterns of varicella zoster virus encephalitis. BK Kleinschmidt-DeMasters, C Amlie-Lefond, DH Gilden. Hum Pathol 1996 Sep;27(9):927-938.

Kleinschmidt-DeMasters - Hum Pathol 1996 abstract / PubMed

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.

Picard - Biomed Pharmacother 1997 abstract / PubMed

Mechanisms of ischaemic stroke after chickenpox. V Ganesan, FJ Kirkham. Arch Dis Child 1997 Jun;76(6):522-525.

Ganesan / Arch Dis Child 1997 full article

Early and late manifestations of cerebral vasculitis related to varicella zoster. MG Hausler, VT Ramakers, J Reul, R Meilicke, G Heimann. Neuropediatrics 1998 Aug;29(4):202-207.

Hausler - Neuropediatrics 1998 abstract / PubMed

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.

Hosseinipour - South Med J 1998 abstract / PubMed

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.

Sebire - Ann Neurol 1999 abstract / PubMed

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.

Caruso / Pediatrics 2001 full article

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.

Askalan - Stroke 2001 abstract / PubMed
Askalan / PSL 2001 news
deVeber / Medscape - Reuters Health news 2001

The expanding specturm of herpesvirus infections of the nervous system. BK Kleinschmidt-DeMasters, DH Gilden. Brain Pathol 2001 Oct;11(4):440-451. "[S]troke due to VZV-mediated large vessel disease (herpes zoster ophthalmicus) occurs predominantly in immunocompetent hosts..."

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. "...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. "Stroke is the final result of the chronic active vasculopathy and results in infarction in the area of the brain supplied by the affected vessel."

Gilden - Herpes 2004 / International Herpes Management Forum (pdf, 6pp)

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cast 01-07-06