title: Varicella Zoster Virus: A Common Cause of Stroke in Children and Adults.
abstract: BACKGROUND
  Varicella zoster virus (VZV) is a neurotropic, exclusively human herpesvirus. Primary infection causes varicella (chickenpox), after which the virus becomes latent in ganglionic neurons along the entire neuraxis. As cell-mediated immunity to VZV declines with advancing age and immunosuppression, VZV reactivates to produce zoster (shingles). One of the most serious complications of zoster is VZV vasculopathy.
  
  
  METHODS
  We reviewed recent studies of stroke associated with varicella and zoster, how VZV vasculopathy is verified virologically, vaccination to prevent varicella and immunization to prevent zoster, and VZV in giant cell arteritis (GCA).
  
  
  RESULTS
  We report recent epidemiological studies revealing an increased risk of stroke after zoster; the clinical, laboratory, and imaging features of VZV vasculopathy; that VZV vasculopathy is confirmed by the presence of either VZV DNA or anti-VZV IgG antibody in cerebrospinal fluid; special features of VZV vasculopathy in children; vaccination to prevent varicella and immunization to prevent zoster; and the latest evidence linking VZV to GCA.
  
  
  CONCLUSIONS
  In children and adults, VZV is a common cause of stroke.
authors.affiliation: Department of Neurology, Seattle Children's Hospital, University of Washington, Seattle, Washington. Electronic address: calefond@seattlechildrens.org.
authors.forename: Catherine
authors.initials: C
authors.lastname: Amlie-Lefond
authors.affiliation: Departments of Neurology and Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Don
authors.initials: D
authors.lastname: Gilden
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002644:Chickenpox / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control / Q000821:virology*; D019433:Chickenpox Vaccine / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D013700:Giant Cell Arteritis / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control / Q000821:virology*; D006562:Herpes Zoster / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control / Q000821:virology*; D014645:Herpesvirus 3, Human / Q000276:immunology / Q000472:pathogenicity*; D054884:Host-Pathogen Interactions; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control / Q000821:virology*; D014611:Vaccination
chemical_list: D019433:Chickenpox Vaccine
keywords: VZV; giant cell arteritis; stroke; vasculopathy