To the Editor.
—Concern for iatrogenic arterial injury was recently raised by the observation of stroke symptoms in two elderly women after shampoo treatment in a beauty parlor.1 The hazard of sustained hyperextension and rotation on vertebral artery flow has not been previously addressed in the elderly population who are disproportionately at risk for cerebrovascular disease. The following five cases suggest that every adult should be made aware of the potential dangers of extreme and sustained neck posture during activities of daily living.
Report of Cases.—Case 1.
—A 79-year-old woman developed vertigo during shampooing, followed by nystagmus and ataxia. Magnetic resonance imaging result was normal but magnetic resonance angiography with dynamic positioning demonstrated marked flow reduction at the atlanto-occipital junction of the right vertebral artery by left rotation and hyperextension (Figure). After this procedure, the patient's symptoms temporarily intensified and returned to baseline after 12 hours.
Weintraub MI. Beauty Parlor Stroke Syndrome: Report of Five Cases. JAMA. 1993;269(16):2085-2086. doi:10.1001/jama.1993.03500160051022