Heightened risk of ischemic stroke after recent herpes zoster ophthalmicus

Comment on ischemic stroke after herpes zoster

“…A large epidemiologic metaanalysis confirmed increased risk of cerebrovascular events after zoster ophthalmicus (HZO) and HZ located elsewhere in the body, outside the head and neck. [2][3][4][5][6] We read with interest the Grose commentary 3 that focused on the pathogenetic role of trigeminal innervations of cranial arteries in the viral spread pathway after HZO, starting from the varicellazoster virus (VZV) infection in childhood, leading to a cerebral vasculopathy in adult age. Apart from HZ reactivation in immunocompromised patients or in the elderly population, where risks factor for stroke increase, the pathogenetic mechanism of a stroke in the absence of characteristic rash or after HZ located outside the head is not obvious, including the location in a cervical dermatome.…”

“…[4][5][6] Previous works 4 documented that stroke after HZ infection is a viral-mediated pathology of the cerebral arteries: HZ is the only human virus that has been proven to replicate in cerebral arteries. [3][4][5][6] The virus uniquely spreads transaxonally after reactivation from trigeminal and other cranial nerve ganglia: afferent fibers from the trigeminal ganglia reach intracranial blood vessels, venous sinuses, and dural structures. 3,4 The viral migration may cause local inflammatory response, occlusion, and ischemia in vessels.…”

“…[3][4][5][6] The virus uniquely spreads transaxonally after reactivation from trigeminal and other cranial nerve ganglia: afferent fibers from the trigeminal ganglia reach intracranial blood vessels, venous sinuses, and dural structures. 3,4 The viral migration may cause local inflammatory response, occlusion, and ischemia in vessels. 3,4 Focal cerebral infarcts associated with HZ infection are mostly reported in the internal carotid, anterior or middle cerebral artery, and vascular territories of the anterior cerebral circulation; this finding was confirmed recently by Maurya et al 6 .…”

“…3,4 The viral migration may cause local inflammatory response, occlusion, and ischemia in vessels. 3,4 Focal cerebral infarcts associated with HZ infection are mostly reported in the internal carotid, anterior or middle cerebral artery, and vascular territories of the anterior cerebral circulation; this finding was confirmed recently by Maurya et al 6 .…”

Varicella zoster virus reactivation antedating ipsilateral brainstem stroke

“…The incidence and severity of VZV is best viewed as relating to a continuum ranging from a natural decline in VZV-specific immunity with advancing age to more serious host immune deficits, as encountered in organ transplant recipients and patients with cancer [1][2][3][4][5][6][7]. Grose [11] suggested heightened risk for ischemic stroke following recent HZO.…”