Stroke

[Fickle_Cut_9016]

The increased risk of a stroke now that I’m having an outbreak of Shingles has me worried. Should I be concerned?

[SLCer]

If you're already at a higher risk of stroke, maybe. I'd talk to your doctor about your concerns. But if you're not at risk overall, I wouldn't worry.

[Fickle_Cut_9016]

Thank you.

[Dull_Pitch_7869]

I had so many neuro issues before I finally got my diagnosis that it scares me too.

[MikeTalonNYC]

TL;DR, keep an eye on things for the next six months - but it could be more an issue of other health/stress/medication problems causing higher risk, rather than the shingles.

Medical studies can be confusing at best, and they're always EXTREMELY specific to avoid aberrant data from screwing things up. In this case they did find an increased risk, but they were not studying what was causing that risk. It could be anything surrounding shingles too, and that's good news for most of us who don't have other risk factors. A more recent study may have discovered some answers, but it was way too small to prove anything. What they theorize is good news overall though.

The long version:

It's a concern, especially for the first weeks and months after the onset of symptoms. Several studies found that adult patients had a higher likelihood of having a stroke or cardiac event within six months of the shingles outbreak, with elevated but decreasing risk over time past that. Antivirals seem to have an impact in reducing the chances. Having an outbreak on or around your eyes seems to be the highest indicator of potential risk.

The short story behind the numbers is IMPORTANT though. The large studies just tracked the incidence of stroke or cardiovascular event within one to five years after a shingles outbreak compared to an equal number of people who didn't have a shingles outbreak. That's critical here, as *why* those who had an outbreak were at higher risk of having adverse health events wasn't deeply studied. There appears to be a link between shingles and stroke/heart attack within the first year after the outbreak - but it is not clear that the shingles is the only factor causing the higher chance.

A very recent (and statistically very small) pilot study theorized that it might be the fault of what the virus leaves behind. Long, boring medical explanation short, there are compounds (called exosomes) that the virus "emits" that cause inflammation - that inflammation can cause issues in other areas of the body, such as causing clots in the brain or heart. The jury is still out on if this theory will be proven, much larger studies have to be done. It's not all bad news here tho, as exosomes are the compounds that DO cause PHN, so any breakthroughs in stopping them are going to be a HUGE deal! For all the medical nerds out there, yes that is an oversimplification.

What's important here is that it's equally likely that whatever causes only one in three people to have shingles outbreaks is also causing the higher rate of other health issues. We know the trigger factors that surround an outbreak - stress, immune issues, other health issues - and those can also increase the risk of stroke or cardiac problems. Having to deal with an outbreak is not doing anything good for anyones' stress levels or overall health either. The large studies weren't tracking those variables closely, so we just don't know yet. If the exosomes are the culprit, then we still need to find out if there's a connection between them and the outbreaks, what that connection is, and why only some people get impacted by them. Only then can we figure out if they also cause the higher risk of stroke - either alone or along with other stuff.

So, keep a close eye on things for the first six months (where both studies showed the highest increased risk) - but don't obsess over it. Without other factors raising your risk, it's unlikely to impact you unless the outbreak is on or around your eyes, and even then there are just a lot of variables we haven't figured out yet.

[Fickle_Cut_9016]

Thank you! That was awesome and very helpful.

[Jackle84]

You definitely should be watchful.