Lying in Wait—Stroke and a Blistering Rash

Stroke following varicella zoster virus (VZV) infection is a well-recognised complication of childhood chicken pox infection. In adults it is less well recognised, although epidemiological data suggests VZV increases stroke risk with a hazard ratio (HR) between 1.3 and 4.28. Cerebral spinal fluid CSF pleocytosis is not required to diagnose VZV vasculopathy and only approximately 30% of cases have CSF VZV DNA detected. This case of a 31 year old male with left upper limb sensory disturbance and headache 7 months after right trigeminal herpes zoster ophthalmicus demonstrates the challenges of diagnosis and treatment of large vessel vasculopathy. The case shows that VZV vasculopathy should be considered in patients with unexplained vasculopathy or cryptogenic stroke, especially if there is a recent history of herpes zoster infection.