title: Increased risk of stroke after a herpes zoster attack: a population-based follow-up study.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Physical Medicine and Rehabilitation, the Neuroscience Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Jiunn-Horng
authors.initials: JH
authors.lastname: Kang
authors.forename: Jau-Der
authors.initials: JD
authors.lastname: Ho
authors.forename: Yi-Hua
authors.initials: YH
authors.lastname: Chen
authors.forename: Herng-Ching
authors.initials: HC
authors.lastname: Lin
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006562:Herpes Zoster / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology*