Rare Beauty Parlour Syndrome case reported in Hyderabad: why did it happen? Should you be worried?

The brain stroke in a 50-year-old Hyderabad woman after a hair wash at a salon, ostensibly because a crucial blood vessel nourishing her brain got compressed and triggered it, has understandably stoked fears and anxieties among women who consider this a routine drill. As tweets neurolog Dr Sudhir Kumar suggested that the fatal crick of the neck might have happened when she tilted her head backwards into the wash basin, there are obviously questions about safety of practices at salons and if women need to be wary about what has become their favourite relaxation drill.
WHAT COULD HAVE HAPPENED?
Says Dr Vinay Goyal, director, Neurology, Institute of Neurosciences, Medanta, Gurugram, “The syndrome occurs when the neck is hyperextended to some extent as a result of a jerk or certain pressure while having your hair shampooed and remaining in that position for an extended period of time. The hyperextension of the neck can cause artery compression from simply changing position, or the bones can slide a little bit one over the other, resulting in carotid or vertebral artery dissection. Dissection is blood vessel tear, resulting in a blood clot that travels to your brain and causes a stroke.” Adds Dr Sahil Kohli, Senior Consultant, Neurology, Neurosciences, Max Hospital, Gurgaon, “There are more chances of hyperextension during bungee jumping or road traffic accidents.”

Dr Vipul Gupta, Director, Neuro-Intervention, Artemis Agrim Institute of Neurosciences, Gurugram, however, believes that with the rise in brain stroke cases in India, the beauty parlour stroke syndrome has become much more common in the recent past. “Although the syndrome is pretty rare, several reports have suggested that over 10 per cent women are at a risk of suffering from a brain stroke while tilting their neck to get a shampoo hair wash at the beauty parlour. The stroke occurs in the PICA area due to cerebral artery dissection or vertebral artery compression in people having one side of the artery thinner than the other, blocking the artery to supply blood to the cerebellum and the brainstem. Symptoms can include severe dizziness, blurry vision, loss of balance, slurry speech and facial numbness.”
As Dr Kumar wrote in his tweet, “This can occur in women with other atherosclerotic risk factors and undetected vertebral hypoplasia. Prompt recognition and treatment can prevent disability,” he wrote.
Though the tweet may have gone viral, the “beauty parlour syndrome” was coined in the Journal of the American Medical Association in 1993 Dr Michael Weintraub after he saw five women who had developed serious neurological symptoms following shampoos at hair salons. Complaints included severe dizziness, loss of balance, and facial numbness. Four out of five suffered strokes, according to The Guardian report of 2016.
SHOULD WOMEN BE CONCERNED? JUST BE CAUTIOUS DURING SERVICE
Dr Goyal assures there’s no reason to panic. “There is no need to be concerned about the condition because it is a very rare occurrence. Millions of people get massages and hair washes at salons on a daily basis and we don’t get very serious cases relating to them. However, staff at these salons should exercise caution when washing and massaging customers, especially the elderly. On their part, customers should request gentle massages rather than vigorous massages, as this may put pressure on the vessels and, as a result, the brain, which might result in stroke. Do check the tilt angle of the sink for your comfort. In addition, it is advised if customers suffer from a recurring pain post-massage, they should immediately consult a doctor instead of waiting it out. I would also advise against getting home massages from the many service providers. While some salons may have trained masseurs, most don’t and would not be aware of protocols. In the end, a wrong move or pressure could prove costly,” he says.
As the vertebral artery runs behind the neck close to the bone and enters the brain, one has to be particularly aware about the push and pull there. Says Dr Kohli, “The most common make parlour hands or any untrained masseurs make is to move the head without supporting the neck and moving rapidly and sharply from one side to the other. These sudden movements are not at all recommended for those predisposed to risks. Even the neighbourhood champiwalla does this indiscriminately. Therefore, I tell all my patients above 65 years, particularly those who have had a cardiovascular event or stroke, to avoid hyperextension altogether. Also, during a hair wash, make sure not to run cold water in winter. It increases blood pressure, a sudden spike of which could be a trigger.”
WHAT HIGH-RISK GROUP SHOULD DO?
In the Hyderabad case, the patient is 50 years old and has controlled hypertension. “Strokes become more common as we age due to a variety of causes such as a blocked artery (ischemic stroke) or leaking or bursting of a blood vessel (haemorrhagic stroke) and some additional risk factors such as smoking, high blood pressure (hypertension), obesity, high cholesterol levels, diabetes, and excessive alcohol consumption. If you are in a high-risk group, just take precautions and ins on gentle and light finger movements to be on the safe side. Always customise any routine to your comfort level,” he adds.
Dr Gupta recommends a more holic routine. “Prevention is best for battling any ailment. So, if you have drug-controlled hypertension, eating an antioxidant-rich diet with vitamins C and E, carotenoids and flavonoids can help in prevention of stroke cases. Keeping the cholesterol in check while avoiding the adoption of poor or unhealthy lifestyle choices can help reduce stroke risk,” he says.
Sharing the diagnosis of the case on Twitter, Dr Kumar wrote, “The woman initially experienced dizziness, nausea, and vomiting. Initially, she was taken to a gastroenterolog, who treated her symptomatically. The symptoms did not improve, and the next day she developed a mild imbalance while walking. She was referred to me for an opinion. The symptoms did not improve, and the next day she developed a mild imbalance while walking. She was referred to me for an opinion. She had mild right-cerebellar signs. MRI brain revealed an infarct in the right posterior inferior cerebellar territory, MR angiogram showed left vertebral hypoplasia.”