Objective:To suggest interim therapeutic guidelines for stroke following truncal herpes zoster on the basis of the first reported Australian case, in a patient who showed good clinical response related temporally to antiviral therapy.Clinical features:A 70‐year‐old patient with no known underlying immune disorder presented with left‐sided hemiplegia one week after right‐sided truncal herpes zoster. In all probability the neurological deficit was due to large artery vasculopathy with thrombosis.Intervention and outcome:Clinical improvement (not to pre‐morbid levels) was noted soon after commencement of antiviral therapy with acyclovir.Conclusion:Stroke following herpes zoster may be a treatable condition. In view of the previously described occurrence of viral antigen within the walls of intracerebral vessels, the occasional progression of the syndrome over months, the generally low toxicity of acyclovir and the clinical response of the few patients treated with antiviral agents to date, early antiviral therapy in patients presenting with delayed contralateral hemiplegia associated with herpes zoster is recommended as prudent.