Rare neck condition could turn salon hair-washing into dangerous stroke risk

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Most of us think of a salon shampoo as a moment of relaxation, when we get to lean back and let the stylist wash and rinse our hair. 

But for a very small number of people, that innocuous posture can set off a cascade of vascular injury known as beauty parlor stroke syndrome (BPSS).

BPSS refers to stroke‐like events triggered by hyperextension or rotation during hair-washing or other activities, which can compress or tear the vertebral arteries in the neck. 

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The term was popularized in 1993, when New York neurologist Michael Weintraub described five case reports of patients who developed symptoms following salon shampoo treatments. 

A recent review published this year in The American Journal of Emergency Medicine identified 54 documented cases of BPSS over nearly five decades, drawn from 22 studies. Among those, 42 cases started in beauty salons, eight in dental settings and four in other contexts. 

Most affected patients (roughly 80%) were women, with ages ranging from teenagers to seniors. 

A 2018 review in Journal of Neurosurgery: Spine stated that BPSS occurs when the neck is held in an extreme backward or twisted position during a wash or treatment, stretching or compressing the vertebral arteries that run along the spine to the brain.

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In rare instances, that posture can cause a tear in the artery wall, called a dissection, which may then form a clot and block blood flow to the brain.

The same review describes how even minor structural issues, such as bone spurs (osteophytes) in the cervical vertebrae, can worsen compression and increase risk. In effect, a casual tilt of the head can briefly limit blood supply to key parts of the brain stem and cerebellum.

Symptoms typically appear during or within several days of a triggering posture, according to the American Journal of Emergency Medicine review.

Common warning signs include dizziness, vertigo, neck pain or visual disturbances. More serious cases may lead to weakness, numbness or speech difficulties.

Diagnosis usually involves MRI or CT angiography to confirm arterial dissection. As with other stroke types, doctors often treat patients using antiplatelet or anticoagulant drugs, though some require vascular stenting or surgery, experts say.

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Health researchers writing for the American Council on Science and Health in New York City emphasize that BPSS is highly uncommon and largely known from isolated case reports rather than population data. 

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Even so, the Pro Beauty Association in Arizona advises stylists to provide neck support like rolled towels or cushions, and to allow clients to sit more upright during washes. 

Experts also recommend that clients speak up immediately if they feel neck strain or dizziness.