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Beauty Parlor Stroke Syndrome in A 32 Year-Old Female: A Case Report

Authors:

Abstract

Purpose To describe a case report of the beauty parlor stroke syndrome in a 32 year old patient Summary: Beauty parlor stroke syndrome, otherwise known as a Hairdresser-related ischemic cerebrovascular event (HICE) or vertebral-basilar ischemia (VBI), is a rare phenomenon caused by either cerebral artery dissection or vertebral artery compression due to neck positioning and manipulation at the hair salon sink bowl. Majority of the cases previously reported occurred in elderly women, rather than younger patients. We describe a case of beauty stroke syndrome in a 32 year-old patient with no prior medical history or risk factors such as atherosclerotic disease, diabetes, hypertension and hyperlipidemia. Conclusion: The 2014 Stroke guidelines issued a warning to healthcare professionals regarding the risk of cervical artery dissections following cervical manipulative therapy in young and middle-aged adults. However, the risk of cervical artery dissection following manipulation at the shampoo bowl was not specifically mentioned. Practitioners must be cognizant of the various symptoms of beauty salon syndrome, and intervene in a timely manner to prevent potential ongoing issues.
Case Report Open Access
Beauty Parlor Stroke Syndrome in A 32 Year-Old Female: A Case
Report
1Assistant Dean for Student Aairs, Associate Professor of Pharmacy Practice, Chicago State University College of Pharmacy, USA
2CVS Caremark, Chicago State University College of Pharmacy, USA
Lalita Prasad-Reddy1* and Luba Burman2
*Corresponding author
Lalita Prasad-Reddy, Assistant Dean for Student Aairs, Associate Professor of Pharmacy Practice, Chicago State University College of Pharmacy,
USA; E-mail: lprasad@csu.edu
Received: February 19, 2021; Accepted: March 03, 2021; Published: March 18, 2021
Journal of Drugs Addiction &
erapeutics
Volume 2(1): 1-2
Keywords: Beauty Parlor Stroke Syndrome, Hairdresser-Related
Ischemic Cerebrovascular Event, Vertebral-Basilar Ischemia
Key points
1.
Beauty parlor syndrome is a rare cause of stroke caused
by either cerebral artery dissection or vertebral artery
compression due to neck positioning and manipulation at
the hair salon sink bowl.
2.
Most case reports have been in elderly or middle aged female
patients but young patients can experience beauty parlor
syndrome as well
3.
Providers should be cognizant of beauty parlor syndrome
being a potential cause of stroke and screen patients
appropriately to intervene
Text
Beauty parlor stroke syndrome, otherwise known as a Hairdresser-
related ischemic cerebrovascular event (HICE) or vertebral-basilar
ischemia (VBI), is a rare phenomenon caused by either cerebral
artery dissection or vertebral artery compression due to neck
positioning and manipulation at the hair salon sink bowl [1].
First reported as a ve case series report in JAMA in 1993, the
cases involved women who developed stroke symptoms such as
ataxia, dizziness, vertigo, as well as in some cases dysarthria and
dysphagia after an extended period of time at the shampoo bowl.
The author concluded that the head-hyperextended position may
be an independent risk factor for stroke and transient ischemic
attack (TIA) in elderly women and this position should be avoided.
Since then, additional reports of beauty parlor stroke syndrome
have been published, although publications have been overall
limited to small case series. Shimura et al identied 12 women
who experienced brainstem and/or cerebellar symptoms within one
day of visiting the beauty salon [2]. The patients’ age ranged from
37-70 and most common symptoms experienced were dizziness,
nausea and hemiparesis. The authors concluded that the head-
hyperextended position, such as the extension over a shampoo bowl
was a risk factor for vascular insufciency, even in middle-aged
women [3]. In 2016, Correia et al described all ischemic strokes
and TIAs in relation to hairdresser visits in a single medical center
from 2002 to 2013. The authors identied ten cases, 90% of which
occurred in females. The average age of the patients was 76 and
they were found to have less major risk factors for stroke such as
hypertension, diabetes, hypercholesterolemia and atrial brillation
than the control group of patients admitted to the medical center’s
acute stroke unit within 24 hours of symptom onset. Out of the 10
patient cases, 2 patients experienced symptoms such as unilateral
head and neck pain immediately following the hairdresser visit
and were found to have carotid artery dissections. Another patient
experienced hemiparesis at the end of the hairdresser visit. The
J Drug Addi er 2021
ABSTRACT
Purpose To describe a case report of the beauty parlor stroke syndrome in a 32 year old patient
Summary: Beauty parlor stroke syndrome, otherwise known as a Hairdresser-related ischemic cerebrovascular event (HICE) or vertebral-basilar ischemia
(VBI), is a rare phenomenon caused by either cerebral artery dissection or vertebral artery compression due to neck positioning and manipulation at the
hair salon sink bowl. Majority of the cases previously reported occurred in elderly women, rather than younger patients. We describe a case of beauty stroke
syndrome in a 32 year-old patient with no prior medical history or risk factors such as atherosclerotic disease, diabetes, hypertension and hyperlipidemia.
Conclusion: e 2014 Stroke guidelines issued a warning to healthcare professionals regarding the risk of cervical artery dissections following cervical
manipulative therapy in young and middle-aged adults. However, the risk of cervical artery dissection following manipulation at the shampoo bowl was not
specically mentioned. Practitioners must be cognizant of the various symptoms of beauty salon syndrome, and intervene in a timely manner to prevent
potential ongoing issues.
Volume 2(1): 2-2
Copyright: ©2021 Lalita Prasad-Reddy. This is an open-access article
distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium,
provided the original author and source are credited.
authors concluded that while hairdresser visits may be a cause
of cervical artery dissection, the data was insufcient to provide
recommendations for persons visiting the hairdresser.
We present a case of a 32 year-old female who presented to the
emergency room with complaints of generalized fatigue, light
headedness, nausea/vomiting, diplopia, left sided weakness, severe
headache and the sensation that she was “going to die”. Prior to
her presentation, she had been working out at the gym, when
symptoms began. Her past medical history was signicant only for
previous miscarriage within the rst trimester > 5 years ago, but
not signicant for any history of astherosclerotic disease, diabetes,
hypertension, hyperlipidemia, or other risk factors. She reported
no major trauma, but reported she had visited the chiropractor
2 months prior for cervical manipulation. Familial history and
social history were not signicant as well. Vitals upon admission
were stable, and at presentation to the emergency room the NIH
Stroke Scale assessment yielded a score of 1, due only to the
presence of ataxia in the left leg. The initial MRI of the brain
demonstrated an acute left cerebellar infarct in the left posterior
inferior cerebellar artery, and further CT of the head conrmed a
left vertebral artery dissection as the suspected cause of the stroke.
Given that the patient was not deemed a candidate for TPA, as
symptoms had begun greater than 4.5 hours prior to her initial
presentation, she was instructed to take aspirin 325 mg daily and
atorvastatin 10 mg once daily as secondary stroke prevention, and
follow up with the neurologist at a later time. NIH stroke index
was 0 twenty four hours after initial presentation and she was
deemed safe for discharge. At later follow-up she was instructed
to continue aspirin and statin therapy, but not considered for a
hypercoagulable work-up given likely cause of stroke.
Two weeks later, the individual returned to the emergency room
with complaints of sudden dizziness, right numbness, bilateral
vision loss reported as “turning upside down then a complete loss
of sight”, and headache. Upon presentation, she denied any recent
trauma, but stated that she had visited the beauty salon twenty
four hours prior to get her hair done. She reported a sedentary
lifestyle for the past month, as she had been concerned about her
previous stroke and potential stroke reoccurrence. NIH stroke scale
was performed with a score of 0, despite a few symptoms. The
initial MRI demonstrated an area of restricted diffusion within the
right parietooccipital lobe, consistent with an acute infarct, and
CT angiograph of the neck demonstrated a new, likely subacute,
small posterior left cerebellar infarct, when compared to the CT
dated one month prior. Signicant stenosis of left vertebral artery
continued to be present. At that time, given the new thrombosis,
she was initiated on heparin drip and admitted to the neurocritical
care unit. After 48 hours, she was discharged with an uneventful
hospital stay, transitioned to enoxaparin therapy with plan to
bridge with warfarin.
MR angiogram was performed three months after initial
presentation. Upon observation, the initial area of dissection was
healed, at which time it was thought that prolonged anticoagulation
was not necessary. She was discontinued off of warfarin therapy
and atorvastatin and recommended to continue with aspirin 81
mg once daily indenitely.
The 2014 Stroke guidelines issued a warning to healthcare
professionals regarding the risk of cervical artery dissections
following cervical manipulative therapy in young and middle-aged
adults. However, the risk of cervical artery dissection following
manipulation at the shampoo bowl was not specically mentioned.
In addition, all of the case reports describing beauty parlor stroke
syndrome involved patients of middle and older age rather than
those 30 y/o or younger. Nonetheless, practitioners must be
cognizant of the various symptoms of beauty salon syndrome, and
intervene in a timely manner to prevent potential ongoing issues.
References
1.
Weintraub MI (1993) Beauty parlor stroke syndrome: report
of ve cases. JAMA 269: 2085-2086.
2. Shimura H, Yuzawa K, Nozue M (1997) Stroke after visit to
the hairdresser. Lancet 350:1778.
3.
Correia PN, Meyer IA, Eskandari A, Michel P (2016) Beauty
parlor stroke revisited: An 11-year single-center consecutive
series. Int J Stroke 11: 356-360.
J Drug Addi er 2021
Citation: Lalita Prasad-Reddy, Luba Burman (2021) Beauty Parlor Stroke Syndrome in A 32 Year-Old Female: A Case Report. Journal of Drugs Addiction & erapeutics.
SRC/JDAT-109. DOI: doi.org/10.47363/JDAT/2021(2)108
ResearchGate has not been able to resolve any citations for this publication.
Article
To the Editor. —Concern for iatrogenic arterial injury was recently raised by the observation of stroke symptoms in two elderly women after shampoo treatment in a beauty parlor.1 The hazard of sustained hyperextension and rotation on vertebral artery flow has not been previously addressed in the elderly population who are disproportionately at risk for cerebrovascular disease. The following five cases suggest that every adult should be made aware of the potential dangers of extreme and sustained neck posture during activities of daily living. Report of Cases.—Case 1. —A 79-year-old woman developed vertigo during shampooing, followed by nystagmus and ataxia. Magnetic resonance imaging result was normal but magnetic resonance angiography with dynamic positioning demonstrated marked flow reduction at the atlanto-occipital junction of the right vertebral artery by left rotation and hyperextension (Figure). After this procedure, the patient's symptoms temporarily intensified and returned to baseline after 12 hours. CASE 2.