Infectious Vasculitis Recommendations for Infectious Vasculitis Referenced studies that support recommendations are summarized in online Data Supplement 51. COR LOE Recommendations In patients with ischemic stroke or TIA and infectious vasculitis such as varicella zoster virus (VZV) cerebral vasculitis, neurosyphilis, or bacterial meningitis, treating the underlying infectious etiology is indicated to reduce the risk of stroke.710 716 In patients with ischemic stroke or TIA in the context of HIV vasculopathy, daily aspirin plus HIV viral control with combined antiretroviral therapy is reasonable to reduce the risk of Synopsis Infectious diseases may cause stroke through vari- ous mechanisms. Direct infection of cerebral arteries by VZV may cause inflammation, endothelial activation, Infectious cardiomyopathies may cause stroke by increasing the risk of cardioembolic stroke, as in the case of Chagas disease.725 728 Infection with HIV may cause stroke by multiple mechanisms, including increased risk of cerebral infection or oppor- tunistic neoplasias, as well as accelerated atheroscle- rosis in the setting of certain antiretroviral agents.729,730 Basilar meningitis caused by Mycobacterium tubercu- losis, Treponema pallidum, or Cryptococcus may cause stroke by contiguous spreading of the inflammation in the cerebrospinal fluid to the brain arteries at the base of the skull.731 734 Recommendation-Specific Supportive Text 1. Stroke associated with CNS infection should be considered a life-threatening emergency and should be triaged accordingly. The risk of stroke recurrence depends on the underlying infection, and the treat- ment should be target as indicated. It may be help- ful to consult with an infectious disease expert as needed. VZV vasculitis may present with large and small artery strokes in the context of arterial luminal irregularities, beading, or stenosis.710,711 Patients in whom VZV vasculitis is suspected should undergo a lumbar puncture for anti-VZV immunoglobulin G, immunoglobulin M, and polymerase chain reaction. 