Beauty Parlor Stroke Syndrome Case Study
“Dave Tyler, 45, told the Daily Mail that two days after he visited a salon in Brighton, he started having headaches and collapsed during a business meeting.
He also felt his body go numb.
Mr Tyler spent three months in hospital before learning to walk again with a stick, but he still can’t drive and is often in pain.
Although he didn’t feel any discomfort at the time his hair was being washed, he told BBC Radio 5 live that hairdressers should “be aware that something like this is possible”.
He settled out of court and was paid £90,000 by the hairdressing salon in February.”
What Exactly is Beauty Parlor Stroke Syndrome
When your neck is hyperextended over the edge of a shampoo bowl, the pressure and/or whiplash-like motions on your neck can lead to a tear in the vertebral artery, which supplies blood to your brain. Dr. Steven R. Zeiler, head of stroke research at Johns Hopkins, said
Vertebrobasilar insufficiency (VBI) or vertebral-basilar ischemia, also called beauty parlor syndrome (BPS), is a temporary set of symptoms due to decreased blood flow (ischemia) in the posterior circulation of the brain. The posterior circulation supplies blood to the medulla, cerebellum, pons, midbrain, thalamus, and occipital cortex (responsible for vision).
Beauty parlor syndrome (BPS) or vertebrobasilar insufficiency (VBI) is an uncommon event which can cause a transient ischemic attack (TIA) or stroke (CVE). The prolonged hyperextension and or rotation of a person’s neck whilst over a wash basin can cause a TIA or CVE through two proposed mechanisms – mechanical occlusion or arterial dissection. Both are uncommon and typically only seen in those with a connective tissue disorder or are vascularly compromised through atherosclerosis, diabetes or anatomical variations.
The arteries, in this case, are the vertebral arteries. Both arise from the subclavian arteries on each side of your neck and enter deep to the transverse process at C6 and progress upwards through the tunnels of the transverse foramen the atlas. Once here they travel through the much bigger foramen magnum where the two sides join to form the basilar artery. The basilar artery has a few smaller connecting arteries but ultimately it joins The Circle of Willis.
The blood flow from the vertebral arteries supplies blood to the muscles in the anterior part of the neck, the posterior parts of the brain and the cerebellum. Hence why the majority of symptoms of BPS are vertigo, nystagmus, ataxia, slurred speech, wernike’s aphasia or drop attacks.
The artery is mostly outside of the skull and due to its position in the neck, it has to be highly mobile due to rotational movements of the head. Therefore, it is vulnerable to occlusion and trauma as seen in BPS. Ultimately this injury is much more likely to occur in something like bungee jumping or in road traffic collisions. As they aren’t as innocuous as getting your hair cut they don’t get the same coverage but the mechanism is still the same.
It is likely that many physical therapists will be approached by patients about this happening to them. Advice for those who are vulnerable or worried about this unlikely event occurring would be to avoid the compromising position of hyperextension and rotation for too long, to use a cushion or rolled up towel at the basin to reduce the total amount of extension or to slowly move your head into the position and to avoid a retching motion.
What Causes Beauty Parlor Stroke Syndrome?
When your neck is hyperextended over the edge of a shampoo bowl, the pressure and/or whiplash-like motions on your neck can lead to a tear in the vertebral artery, which supplies blood to your brain. Dr. Steven R. Zeiler, head of stroke research at Johns Hopkins, told BuzzFeed:
“When one of those cervical arteries is damaged in some sort of way, you can get what’s called a dissection, which is damage of the inside of the blood vessel, leading to abnormal flow and clotting, and then those clots can shoot north into the brain and cause a stroke.”
Having your hair washed is not the only act that can cause this — far from it — although it’s very rare, even when all potential causes are considered.
In a conversation with The Atlantic, Dr. Richard Bernstein, medical director of the Comprehensive Stroke Center at Northwestern Memorial Hospital in Chicago, explained that the phenomenon can occur due to innocent stretching, sneezing or even getting out of bed wrong in the morning, noting, “It is so rare that it’s a waste of time to worry about it. It’s so unlikely, and there’s really nothing you can do to prevent it.”