Vertebrobasilar Disease and Beauty Parlor Stroke Syndrome
To the editor:
My elderly mother had a brainstem stroke a few months ago. She had the sudden onset of dysarthria, dysphasia and minimal right-sided impairment of the extremities. I learned that she had gone to the beauty parlor the day before her stroke and had her hair washed and set.
Blood flow studies revealed blockage of the right vertebral artery, and magnetic resonance imaging suggested lacunar lesions in the brainstem. Most studies support the hypothesis that impairment or even stoppage of blood flow in the vertebrobasilar system can result from cervical spine extension accompanied by rotation or even by rotation alone. ref 1,2
Although the preponderance of cases have been associated with cervical spine manipulation, other factors that have been mentioned include sports injuries. (some being treated by cervical manipulation), overhead painting, prolonged overhead gazing, gymnastics and calisthenics maneuvers and yoga. ref 1,3-5 Weintraub's case studies ref 2,6 linked stroke with the precarious position of the head and neck at the shampoo bowl.
Warning the public about the possible dangers of extreme cervical spine movements (e.g., at the beauty parlor shampoo bowl or during spinal manipulation) may help prevent vertebrobasilar system compromise No one knows how many cases of vertebrobasilar insult relate to spinal manipulation. History-taking of patients with symptoms of vertebrobasilar disease should include questions about any recent trips to the beauty parlor or recent cervical spine manipulation.
JOSEPH S. STRATIGOS, M.D.
1. Krueger BR, Ozaki H. Vertebral-basilar distribution infarction following chiropractic cervical manipulation. Mayo Clin Proc 1980;55:322-32.
2. Weintraub MI. Beauty parlor stroke syndrome:
report of five cases [Letter). JAMA 1993;269:2085-6.
3. Fast A, Zinicola DF, Marin EL. Vertebral artery
damage complicating cervical manipulation. Spine
4. Schellhas KP, Latchaw LIZ, Wendling LR, Gold LH. Vertebrobasilar injuries following cervical manipulation. JAMA 1980;244:1450-3.
5. Katirji MB, Reinmuth OM, Latchaw RE. Stroke due to vertebral artery injury. Arch Neurol 1985;42:242-8.
6. Weintraub MI. Beauty parlor stroke syndrome: report of two cases [Letter). Neurology 1992;42 (Suppl): 340.