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(Stroke. 2009;40:3443.)
© 2009 American Heart Association, Inc.

Original Contributions

Increased Risk of Stroke After a Herpes Zoster Attack

A Population-Based Follow-Up Study

Jiunn-Horng Kang, MSc, MD; Jau-Der Ho, PhD, MD; Yi-Hua Chen, PhD Herng-Ching Lin, PhD

From the Department of Physical Medicine and Rehabilitation (J.-H.K.), the Neuroscience Research Center (J.-H.K.), and the Department of Ophthalmology (J.-D.H.), Taipei Medical University Hospital, Taipei, Taiwan; and the School of Public Health (Y.-H.C.), the School of Health Care Administration (H.-C.L.), and the Dr. Chi-Chin Huang Stroke Research Center (H.-C.L.), Taipei Medical University, Taipei, Taiwan.

Correspondence to Herng-Ching Lin, PhD, School of Health Care Administration, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan. E-mail henry11111{at}tmu.edu.tw

Background and Purpose— Varicella zoster virus-induced vasculopathy and postherpes zoster attack stroke syndromes have been reported previously; nevertheless, data regarding the exact prevalence and risk of stroke occurring postherpes zoster attack are still lacking. This study aims to investigate the frequency and risk of stroke after a herpes zoster attack using a nationwide, population-based study of a retrospective cohort design.

Method— A total of 7760 patients who had received treatment for herpes zoster between 1997 and 2001 were included and matched with 23 280 randomly selected subjects. A 1-year stroke-free survival rate was then estimated using the Kaplan-Meier method. After adjusting for potential confounders, Cox proportional hazard regressions were carried out to compute the adjusted 1-year survival rate.

Results— Of the sampled patients, 439 patients (1.41%) developed strokes within the 1-year follow-up period, that is, 133 individuals (1.71% of the patients with herpes zoster) from the study cohort and 306 individuals (1.31% of patients in the comparison cohort) from the comparison cohort. The log rank test indicated that patients with herpes zoster had significantly lower 1-year stroke-free survival rates than the control (P<0.001). The adjusted hazard ratios of stroke after herpes zoster and herpes zoster ophthalmicus during the 1-year follow-up period were 1.31 and 4.28, respectively.

Conclusion— The risk for stroke increased after a zoster attack. Although varicella zoster virus vasculopathy is a well-documented complication that may induce a stroke postherpes zoster attack, it does not fully account for the unexpectedly high risk of stroke in these patients.

Key Words: herpes zoster • herpes zoster attack • stroke