Cerebrovascular accident is the second most common cause of death in the world. Herpes zoster (HZ) is reported to be a major trigger of the stroke syndrome. Considering the high prevalence of stroke in Iran, we carried out a study to assess the correlation between stroke and HZ. This is one of the very few studies carried out on this correlation in Asian nations. One hundred and five cases and 105 controls were included in this study. The cases had been diagnosed with stroke by a neurologist and confirmed by brain imaging. The controls had never had any type of stroke. Both groups were between 30 and 90 years of age. We looked for the HZ infection in both groups. Logistic regression analysis was used to evaluate the association between stroke and HZ. The mean age of the cases was 63.95 ± 12.24 years and the man age of the controls was 66.99 ± 14.58 years. There was a significant difference in the HZ infection between the cases and the controls (P < .0001). Head zoster (including ophthalmic zoster) was significantly higher in the case group than the control group (P < .0001). The risk of stroke was the highest 2-4 weeks after the onset of HZ and the incidences of ischemic stroke were higher than those of hemorrhagic stroke (P < .0001). In an analysis adjusted for the age, sex, and hypertension, HZ was found to be associated with an increased risk of stroke (odds ratio, 5.84; 95% confidence interval, 1.98-8.23). Close monitoring is suggested for cerebrovascular diseases in patients who have had the head zoster, especially in the first month after the infection.

Introduction: Tuberculous meningitis (TBM) is the most fatal form of tuberculosis. Despite adequate treatment, its mortality and morbidity is high. Clinical, laboratory, and radiologic findings help in diagnosis of TBM, although analysis of cerebrospinal fluid (CFS) might sometimes delay and mislead the rapid diagnosis. Case Presentation: We present a 14-year-old Afghan immigrant male, with uncommon laboratory results of advanced TBM, who referred to Baharloo hospial in Tehran, Iran, in September 2016. He experienced headache and anxiety one month prior to referring to the hospital; he had fever, severe headache, vomiting and showed bizarre behavior 7 days before admission. Suspecting meningoencephalitis, the physician advised empirical treatment. The first CSF revealed polymorphonuclear (PMN) predominance with low glucose, which was repeated in the second and third CSF analysis. This pattern indicates early phase of TB meningitis. In day 4, antituberculous treatment with corticosteroid was administered empirically. Unfortunately, he succumbed to disease in day 36. Polymerase chain reaction (PCR) for mycobacterium tuberculosis (MTB) in CSF was positive. The patient's presentation (lethargic to coma) and brain computed tomography (CT) scan indicated advanced stage of disease. Conclusions: All physicians should consider TB meningitis in any patient with low glucose even with serial PMN predominance in CSF.