Background and Purpose— Varicella zoster virus-induced vasculopathy and postherpes zoster attack stroke syndromes have been reported previously; nevertheless, data regarding the exact prevalence and risk of stroke occurring postherpes zoster attack are still lacking. This study aims to investigate the frequency and risk of stroke after a herpes zoster attack using a nationwide, population-based study of a retrospective cohort design. Method— A total of 7760 patients who had received treatment for herpes zoster between 1997 and 2001 were included and matched with 23 280 randomly selected subjects. A 1-year stroke-free survival rate was then estimated using the Kaplan-Meier method. After adjusting for potential confounders, Cox proportional hazard regressions were carried out to compute the adjusted 1-year survival rate. Results— Of the sampled patients, 439 patients (1.41%) developed strokes within the 1-year follow-up period, that is, 133 individuals (1.71% of the patients with herpes zoster) from the study cohort and 306 individuals (1.31% of patients in the comparison cohort) from the comparison cohort. The log rank test indicated that patients with herpes zoster had significantly lower 1-year stroke-free survival rates than the control ( P <0.001). The adjusted hazard ratios of stroke after herpes zoster and herpes zoster ophthalmicus during the 1-year follow-up period were 1.31 and 4.28, respectively. Conclusion— The risk for stroke increased after a zoster attack. Although varicella zoster virus vasculopathy is a well-documented complication that may induce a stroke postherpes zoster attack, it does not fully account for the unexpectedly high risk of stroke in these patients.

Background and Purpose— No previous study has investigated the incidence or risk of cerebrovascular diseases developing after the sudden sensorineural hearing loss (SSNHL). This study sets out to estimate the risk of stroke development among SSNHL patients during a 5e-year follow-up period after hospitalization for acute episodes of SSNHL. Methods— Our study design features a study cohort and a comparison cohort. The study cohort consists of all patients hospitalized with a principal diagnosis of sudden hearing loss (n=1,423), whereas the control cohort comprised all patients hospitalized for an appendectomy in 1998 (n=5692) as a surrogate for the general population. Each patient was tracked from hospitalization in 1998 until the end of 2003. Cox proportional hazard regressions were performed as a means of computing the 5-year stroke-free survival rates after adjustment for possible confounding factors. Results— Of the total sample, 621 patients (8.7%) had strokes during the 5-year follow-up period: 180 (12.7% of the SSNHL patients) from the study cohort and 441 (7.8% of patients undergoing an appendectomy) from the control cohort. After adjusting for other factors, the hazard of stroke during the 5-year follow-up period was 1.64-times (95% CI, 1.31 to 2.07; P <0.001) greater for SSNHL patients than for appendectomy patients. Conclusions— Our findings suggest that SSNHL can be an early warning sign of impending stroke. We suggest that SSNHL patients should undergo a comprehensive hematologic and neurological examination to help clinicians identify those potentially at risk for stroke developing in the near future.

Epilepsy is the most common major neurologic complication in pregnancy, with estimated prevalence among pregnant women ranging from 0.2% to 0.7%.^1-3 While approximately 40% of the 18 million women with epilepsy (WWE) in the world are of child-bearing age, managing maternal epilepsy and monitoring the health of the developing fetus remain some of the most perplexing and engaging issues in the fields of neurology and obstetrics.⁴

Background: Epidural or spinal anesthesia involves several mechanisms hypothesized to reduce risk of surgical site infections (SSIs) during this decisive period. This study aims to compare the risk of SSI within 30 days of surgery for patients receiving total hip or knee replacement under general anesthesia versus those under epidural or spinal anesthesia. Methods: We used the Longitudinal Health Insurance Database of Taiwan. A total of 3,081 patients who underwent primary total hip or knee replacement from 2002 to 2006 were included in the study. Multivariate logistic regression and propensity score analyses were carried out to explore the relationship between method of surgical anesthesia and SSI occurring within 30 days of surgery. Results: Of the 3,081 sampled patients, 56 patients (1.8%) had 30-day SSIs; 33 (2.8% of all under general anesthesia) of them had general anesthesia, and 23 (1.2% of all under epidural or spinal anesthesia) had epidural or spinal anesthesia (P = 0.002). The odds of SSI for patients receiving total hip or knee replacement under general anesthesia were 2.21 (95% CI = 1.25-3.90, P = 0.007) times higher than those who had the same procedure under epidural or spinal anesthesia, after adjusting for the patient's age, sex, the year of surgery, comorbidities, surgeon's age, and hospital teaching status. Conclusions: Total hip or knee replacement under general anesthesia is associated with higher risk of SSI compared with epidural or spinal anesthesia. Our results support the evolving concept of long-term consequences of anesthesia and emphasize the anesthesiologist's role in preventing SSIs.

Empirical findings on the prospective link between obstructive sleep apnea (OSA) and subsequent depression are mixed. This nationwide, population-based study thus aimed at assessing the risk of depressive disorder within the first year following a diagnosis with OSA. Gender effects were further examined. Cohort study. Taiwan. This study used data from the Longitudinal Health Insurance Database 2000. A total of 2,818 patients diagnosed with OSA between 2002 and 2008 were evaluated, and 14,090 matched non-OSA enrollees used as a comparison cohort. Each patient was followed for one year to identify subsequent depressive disorder. We found that during the one-year follow-up, the incidence of depressive disorder per thousand person-years was about twice as high among patients with OSA (18.10, 95% CI = 13.62-23.61) as those without OSA (8.23, 95% CI = 6.83-9.84). The Cox proportional hazards model revealed that patients with OSA were independently associated with a 2.18 times (95% CI = 1.55-3.08) increased risk of subsequent depressive disorder within a year, compared to those without OSA. As epidemiological studies have consistently documented an increased risk for depression in women, we hypothesized and confirmed higher risks of depressive disorder among female patients with OSA (2.72, 95% CI = 1.68-4.40) than their male counterparts (1.81, 95% CI = 1.09-3.01). A prospective link between OSA and subsequent depressive disorder within one year was confirmed by the current study. The risk was particularly evident among women. Regular psychiatric screening among patients with OSA is suggested to prompt the timely detection of depression. A commentary on this article appears in this issue on page 425.