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September 8, 1993

Beauty Parlor Stroke: When a Beautician Becomes a Physician-Reply

Author Affiliations

New York Medical College Valhalla

JAMA. 1993;270(10):1198-1199. doi:10.1001/jama.1993.03510100048025

In Reply.  —I wish to thank Drs Beringer and Golden for this opportunity to expand on my article. Beringer wants more information. Patients 1 and 5 developed acute neurological dysfunction during the shampoo procedure, bringing it to a halt. In each case, the patient was immediately hospitalized. Patients 2,3, and 4 noted symptoms of brainstem dysfunction at the conclusion of the shampooing procedure when they stood up. They subsequently sought medical attention.The biomechanics of the shampooing procedure require the head to be placed in a recessed sink with the assumption of the hanging neck and head position. Reliable data about the extent and duration of forces applied by different beauticians, as well as the specific angulation achieved and the ischemic threshold of the individual, are not known nor have they ever been standardized. Despite these theoretical drawbacks and lack of quantification, the occurrence of stroke during this procedure suggests