Beauty Parlour Stroke: Medical and salon experts weigh in on remedial measures

Days after Hyderabad-based neurologist Dr Sudhir Kumar on Twitter brought to light the case of a 50-year-old woman experiencing a stroke after hair-washing at a salon, 'Beauty Parlor Stroke Syndrome', as the doctor describes it, has intrigued many about the possible causes and frequency of the condition.

The woman, who was referred to Kumar, experienced dizziness, nausea and vomiting, which started during a shampoo hair-wash session at the parlour. As the symptoms aggravated, she developed a mild imbalance while walking. Kumar states that an MRI of the brain showed signs of infarction (obstruction of blood supply to one organ or a region of a tissue) in the right posterior cerebellar region of the brain.

Further diagnosis revealed that the woman suffered from beauty parlour stroke in the right posterior inferior cerebellar artery or the PICA, which originates from the vertebral artery and is one of the most vital arteries supplying blood flow to the cerebellum. The cerebellar region of the brain controls functions related to movement and coordination and is located behind the brain stem.

"Possible mechanism is kinking of vertebral artery during hyperextension and turning of neck towards wash-basin while washing hair with shampoo," the doctor tweeted. The doctor further stated that such a stroke in the vertebrobasilar arteries (supplying blood flow to the cerebellar region) can occur during hair services at a salon, especially in women with other atherosclerotic risk factors and undetected vertebral hypoplasia, a condition defined by underdevelopment of vertebral artery.

Dr Ashish Gosar, consultant neurologist at Masina Hospital explains that the phrase, beauty Parlor stroke syndrome was coined in 1993 by Dr M. Weintraub in the Journal of the American Medical Association. The research revealed that five women who visited salons for hair shampoo later reported developing severe neurological symptoms such as dizziness and loss of balance and at least four women suffered from strokes.

Common causes and symptoms
Experts Gosar and Dr. Sonali Kohli, venereologist at the dermatology department of Sir H. N. Reliance Foundation Hospital and Research Centre state that certain neck movements during cosmetic treatments and hair services at beauty parlours and salons may cause a degree of strain on the blood vessels leading to a dissection in extreme cases, thereby obstructing the blood flow to the posterior part of the brain. However, it is a rare condition.

According to Kohli, when one is angulating their head for a hair-wash at a salon, it must not extend 20 degrees. "When one of these arteries (vertebral basilar artery territory) could be too thin and the other arteries hyper flexed or extended, or kinked, it can cause the stroke to occur. It is important even during home massages. Some people also have a habit of jerking the neck to hear the crackling sound that also can sometimes lead to a stroke through this arterial area and it is risky," she notes.

While people may experience pain or discomfort in their neck and back area during massages or other procedures frequently depending on the seating arrangement and other health factors. Sana Dhanani, founder of The White Door India, which specialises in offering spa services, states that many a times establishments are not completely equipped with the right tools, equipment, and sometimes the right training when conducting a hair service.

"One can witness a strain on the neck especially in-chair services that require a customer to lean back for their wash. Depending on the discomfort individuals may experience in muscle tension, neck pain, and an overall unpleasant experience," she adds.

Moreover, as Gosar adds, people with existing vascular risk factors such as hypertension and diabetes and those who smoke are more prone to such incidents, irrespective of their age group. The symptoms mainly include dizziness, vomiting, imbalance and slurred speech.

Precautionary measures to prevent the condition
Gosar, Kohli and Dhanani say it is a two-way process to navigate parlour services and any challenges that follow. Conscious effort must be made to avert risks by providing suitable equipment by salon managers and the individuals availing such services must be aware of any underlying physical conditions in addition to their movements.

1. People should make sure that no amount of extreme pressure is subjected to the neck for prolonged periods. One is advised to not be careless and be mindful during neck maneuvers.

2. Now the triggers in the parlour are usually because of the angulation or if there is excessive pressure applied while washing the hair on the angulation of the neck. The salon staff needs to exercise extreme caution in terms of putting less stress over the neck muscles.

3. The symptoms to watch out for are usually most commonly present with dizziness. The patient might feel that they're having a similar pass out episode. And in certain cases, there is also a slight numbing effect which can be felt. In case any symptoms occur after such a neck maneuver, make sure to see a neurologist at the earliest.

4. In case of any symptoms at the salon, it is important to start monitoring the blood pressure of the patient and also to aid them to an area which is secure and clear and to follow all the necessary first aid precautions which should be given at such a time.

5. Strokes become common with age and in some cases it can be due to a blocked artery, or because of bursting of a blood vessel. Other risk inducing factors are smoking, hypertension, diabetes, excessive alcohol consumption and obesity. People must be careful of these triggers.

6. At salons, reclining chairs and flexible sink angles should be considered necessary to relieve pressure on the neck and spine.

7. Proper staff training is crucial to ensure that the client is always comfortable; pulling and tugging should be avoided, and constant communication concerning the application of pressure should be brought up during the service.

8. Constant customer feedback is critical for improving any service experience. Clients must be encouraged to speak up when services are unsatisfactory, which further prompts management to intervene and take corrective action.

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