The clinical, CSF, imaging, and virological features of varicella zoster virus (VZV) vasculopathies in 30 patients (7 children) are reviewed by researchers at various centers in the US and internationally. The data obtained on the 7 children, ages 1-7 and 18, show rash in 5, CSF pleocytosis in 6, focal lesions on MRI/CT in 7, focal vascular abnormalities by angiography or MRA in 3 of 4 tested, small vessel involvement in 2 and mixed in 5, CSF VZV DNA in 2, and IgG in 5, and reduced serum/CSF ratio of VZV IgG in 5, confirmation of intrathecal synthesis. Average time from rash to neurologic symptoms and signs and virologic analysis was 4.1 months. In children it varied from 1-2 days to 3 months. Detection of anti-VZV IgG antibody in CSF is a more sensitive indicator of VZV vasculopathy than VZV DNA (p < 0.001). Of 15 patients (13 adults and 2 children) treated with IV acyclovir alone for 10-28 days, 66% improved or stabilized compared to 75% of 12 patients (9 adults and 3 children) who received both IV acyclovir and steroids. Of 2 children not treated, 1 stabilized and the other improved slowly. 
COMMENT. VZV is a possible cause of stroke in children and adults, even without a history of rash. Prior rash was absent in 29% of children and in 40% of the total group. Symptoms of vasculopathy can be delayed up to 3 months after the rash in children, 4 months in adults. CSF pleocytosis was present in the majority (86%) of children, but absent in 33% of the total group.
Acute infection, viral or bacterial, is a risk factor for cerebral infarction and stroke in all age groups. The reported prevalence of infection in the week preceding ischemic stroke ranges from 10% to 35%. Influenza vaccination has been correlated with a lower risk of stroke. 
Herpes zoster live-attenuated vaccine in elderly subjects was effective and increased VZV-T cell-mediated immunity within 6 weeks after vaccination. Boosting immunity by vaccination should protect older adults against herpes zoster and postherpetic neuralgia, at least 4 years or longer.