{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T02:00:07Z","timestamp":1793325607630,"version":"4.5.0"},"reference-count":77,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Varicella Zoster Virus (VZV), responsible for chickenpox and herpes zoster, has emerged as a significant contributor to cerebrovascular disease. Mounting evidence indicates that VZV reactivation may precipitate ischemic and hemorrhagic stroke through mechanisms of viral vasculopathy, immune evasion, and vascular inflammation. While antiviral therapy remains the cornerstone of treatment, several adjunctive regimens exhibit encouraging results in controlling endothelial inflammatory response. This targeted review synthesized findings from 31 studies, including clinical cohorts, in vitro models, and pathological analyses, to evaluate the relationship between VZV and stroke, with emphasis on treatment management beyond antivirals. Evidence demonstrates that VZV antigens are frequently detected within cerebral arteries, where they induce transmural inflammation, endothelial dysfunction, and thrombosis, thereby increasing stroke risk, particularly in the weeks following herpes zoster. Adjunctive therapies such as corticosteroids, statins, and resveratrol show promise in mitigating vascular inflammation, though clinical validation is limited. Preventive measures, especially zoster vaccination, significantly reduce herpes zoster incidence and may lower subsequent stroke risk, yet global uptake remains insufficient. Collectively, the data underscore the need for improved diagnostic tools, combination treatment strategies, and expanded vaccination programs to address the substantial public health burden of VZV-associated stroke.<\/jats:p>","DOI":"10.3390\/v17121591","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T09:17:36Z","timestamp":1765185456000},"page":"1591","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Varicella Zoster Virus and Stroke: An Intricate Relationship"],"prefix":"10.3390","volume":"17","author":[{"given":"Achilleas","family":"Livieratos","sequence":"first","affiliation":[{"name":"Independent Researcher, 15238 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars Erik","family":"Schiro","sequence":"additional","affiliation":[{"name":"Independent Researcher, 0284 Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charalambos","family":"Gogos","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Patras, 26504 Rio, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0629-9248","authenticated-orcid":false,"given":"Georgios","family":"Ntaios","sequence":"additional","affiliation":[{"name":"1st Medical Propedeutic Department of Internal Medicine & Stroke Unit, AHEPA Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4289-9494","authenticated-orcid":false,"given":"Karolina","family":"Akinosoglou","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Patras, 26504 Rio, Greece"},{"name":"Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, 26504 Rio, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"102868","DOI":"10.1016\/j.jiph.2025.102868","article-title":"Global, regional, and national burden of varicella-zoster infections in adults aged 70 years and older from 1997 to 2021: Findings from the Global Burden of Disease Study","volume":"18","author":"Yang","year":"2025","journal-title":"J. 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