Herpes zoster ophthalmicus and granulomatous angiitis. An ill-appreciated cause of stroke

No causal link between herpes zoster and ischemic stroke: evidence from Mendelian randomization study

OBJECTIVE

The association between herpes zoster (HZ) and stroke has been the subject of much previous research. Nevertheless, the connection remains ambiguous. A two-sample Mendelian randomisation study was conducted to explore the potential causal link between HZ and ischaemic stroke, including its subtypes.

METHODS

For our MR analysis, we identified genetic instrumental variables related to both HZ and stroke by screening two prominent publicly accessible genome-wide association study databases. The primary approach involved using the inverse variance weighting method. To supplement this, we also employed methods such as MR-Egger regression, the weighted median approach, simple and weighted models. Lastly, to ascertain the stability and reliability of the results, we conducted tests for heterogeneity detection, horizontal pleiotropy assessment, and a leave-one-out analysis.

RESULTS

The genetically predicted HZ did not indicate an association with stroke risk ([OR] 1.041; 95% [CI] 0.958-1.131;p = 0.336). This lack of association also held true for different subtypes of stroke: ischaemic stroke (OR = 1.047, 95% CI = 0.955-1.148, p = 0.323), large vessel stroke (OR = 1.13, 95% CI = 0.90-1.41, p = 0.272), cardioembolic stroke (OR = 1.020, 95% CI = 0.859-1.211, p = 0.816), small vessel stroke (OR = 1.14, 95% CI = 0.93-1.40, p = 0.195), and lacunar stroke (OR = 1.195, 95% CI = 0.967-1.476, p = 0.097).

CONCLUSION

This MR study showed that not uncover a causal link between herpes zoster and ischaemic stroke. Additional research will be necessary in the future to shed light on the fundamental mechanisms involved.

Varicella zoster virus and cardiovascular diseases

Varicella zoster virus (VZV) is a Herpesviridae family double-stranded DNA virus that only affects humans. The first clinical manifestation appears to be varicella, typical of childhood. VZV, on the other hand, becomes latent in ganglion neurons throughout the neuroaxis after primary infection. The VZV reactivates and travels along peripheral nerve fibers in the elderly and immunocompromised individuals, resulting in Zoster. It can, however, spread centrally and infect cerebral and extracranial arteries, resulting in vasculopathy, which can lead to transient ischemic attacks, strokes, aneurysms, cavernous sinus thrombosis, giant cell arteritis, and granulomatous aortitis. Although the mechanisms of virus-induced pathological vascular remodeling are not fully understood, recent research indicates that inflammation and dysregulation of ligand-1 programmed death play a significant role. Few studies, on the other hand, have looked into the role of VZV in cardiovascular disease. As a result, the purpose of this review is to examine the relationship between VZV and cardiovascular disease, the efficacy of the vaccine as a protective mechanism, and the target population of heart disease patients who could benefit from vaccination.

A pox upon your house

Herpes zoster ophthalmicus (HZO) is a common viral infectious disorder affecting the ophthalmic division of the trigeminal nerve. A small subset of HZO patients present with the ophthalmic symptoms, but without an accompanied rash, a condition described as Herpes zoster sine herpete. Although HZO is well known to be associated with other central nervous system abnormalities, encephalitis and cerebral infarction are atypical and uncommon. We report an unusual case of presumed unilateral Herpes zoster ophthalmicus sine herpete that presented with trigeminal pain and uveitis and then progressed to encephalitis and bilateral cerebral infarctions despite treatment with acyclovir and corticosteroids. The diagnosis of HZV was confirmed by polymerase chain reaction testing on the cerebrospinal fluid.

Cerebrospinal fluid analysis in the diagnosis and treatment of arterial ischemic stroke

With the advent of magnetic resonance imaging as a rapid and accurate way to diagnose arterial ischemic stroke, cerebrospinal fluid assessment is rarely performed, unless infectious or inflammatory processes are obvious. Recent advances in the understanding of the pathophysiology of childhood stroke have implicated a growing list of discrete or occult infectious and inflammatory conditions which may involve intracranial arteries and neighboring structures. Cerebrospinal-fluid assessment may allow the detection of markers identifying processes (including infectious, inflammatory, metabolic, and traumatic) potentially involved in cerebral vasculopathy and stroke. The analysis of cerebrospinal fluid in arterial ischemic strokes, including apparently idiopathic strokes, may yield essential information on pathophysiology, allowing for optimal therapeutic decisions and prognostic considerations.

Recommendations for the management of herpes zoster

The objective of this article is to provide evidence-based recommendations for the management of patients with herpes zoster (HZ) that take into account clinical efficacy, adverse effects, impact on quality of life, and costs of treatment. Systematic literature reviews, published randomized clinical trials, existing guidelines, and the authors' clinical and research experience relevant to the management of patients with HZ were reviewed at a consensus meeting. The results of controlled trials and the clinical experience of the authors support the use of acyclovir, brivudin (where available), famciclovir, and valacyclovir as first-line antiviral therapy for the treatment of patients with HZ. Specific recommendations for the use of these medications are provided. In addition, suggestions are made for treatments that, when used in combination with antiviral therapy, may further reduce pain and other complications of HZ.

Varicella-zoster virus: atypical presentations and unusual complications

Varicella-zoster virus (VZV) is the etiologic agent of varicella (primary infection) and herpes zoster (reactivation of latent infection). Although varicella is most often a relatively benign and self-limited childhood illness, the disease can be associated with a variety of serious and potentially lethal complications in both immunocompetent and immunocompromised persons. One complication of varicella that appears to be increasing in frequency is serious bacterial soft tissue infections caused by group A streptococci. Issues related to management of varicella become especially complex when varicella involves pregnant women or susceptible neonates. Herpes zoster can be associated with a variety of neurologic complications, including a syndrome of delayed contralateral hemiparesis. Neurologic complications of herpes zoster, including chronic encephalitis, occur with increased frequency in AIDS patients. VZV retinitis is a potentially sight-threatening complication that occurs in both immunocompetent and immunocompromised persons. Current knowledge regarding pathogenesis and antiviral therapy is reviewed.

The spectrum of cutaneous granulomatous vasculitis: histopathologic report of eight cases with clinical correlation

Cutaneous granulomatous vasculitis is an uncommon histopathologic finding that has been associated with lymphoproliferative disorders, systemic vasculitis, autoimmune inflammatory diseases, and infection. To define further the concept of cutaneous granulomatous vasculitis and to emphasize its clinical importance, we reviewed biopsy material from 8 patients seen from 1985 through 1992. All biopsies showed evidence of blood vessel damage with fibrinoid change or hemorrhage (or both) and granulomatous inflammation in and around vessel walls. Special stains for microorganisms were negative in all cases. Associated medical disorders included neuropathy (2 patients), sarcoid-like disease (2), systemic vasculitis (1), lymphoma and suspected lymphoma (1 each), and associated herpes simplex virus (1). T-cell gene-rearrangement studies were negative in a patient with suspected lymphoma. Granulomatous cutaneous vasculitis is most commonly associated with lymphoma and systemic vasculitis. In selected cases, infection should be considered as an underlying cause.