She Went For a Hair Wash and Ended Up in the ER!
It started as a routine appointment, a simple hair wash at her local salon.
She leaned back, let warm water rinse through her hair, and went on with her day. But within a week, she was in the emergency department, unable to speak, and with complete paralysis on one side of her body. She had suffered a posterior circulation stroke, and the suspected trigger was the way her neck was positioned at the shampoo station.
BP is a 48-year-old woman with no history of atrial fibrillation, no major cardiovascular risk factors, and no recent trauma. Yet, imaging revealed a vertebral artery dissection, a tear in the wall of one of the arteries that supplies blood to the brain stem and cerebellum. It's a rare cause of stroke, but a serious one. And in some cases, it's been linked to nothing more than prolonged or excessive neck extensions, like the kind that happens in a salon chair.
But how could this happen? Let me explain.
The vertebral arteries ascend through the transverse foramina of the cervical vertebrae before merging to form the basilar artery. They're relatively mobile, but in certain positions, especially forced hyperextension or rotation, these vessels can be stretched across bony surfaces like the atlas and axis. In rare cases, mechanical stress can shear the tunica intima, the innermost layer of the artery wall.
This sets off a cascade. Blood enters the subintimal space, forming a dissecting hematoma. This narrows the lumen, impedes flow, and can also create the nidus for thrombus formation. If that thrombus embolizes or if the narrowing becomes hemodynamically significant, a stroke follows.
What makes vertebral artery dissections particularly dangerous is that their presentation can be subtle. Early symptoms often include vertigo, imbalance, nausea, and headache, which are easily mistaken for benign causes. But the posterior circulation supplies critical structures of the brain stem, cerebellum, and occipital lobes. A disruption here can lead to catastrophic outcomes: respiratory failure, locked-in syndrome, or death.
This phenomenon is sometimes referred to informally as beauty parlor stroke syndrome. It's rare but well-documented in the medical literature. Most cases involve people with no overt trauma, just prolonged cervical extension.
One study linked dissection to a chiropractic manipulation, a similar mechanical force applied to the cervical arteries. So how do you prevent it? For most healthy people, the risk is minimal. But for those with underlying conditions such as hypertension, fibrovascular dysplasia, connective tissue disorders, or prior dissections, it's worth taking precautions.
1) Avoid extreme neck extension.
2) Use proper support behind the cervical spine.
3) Ask for a forward wash instead of leaning back.
These aren't overreactions. There are low-effort ways to prevent a low-probability but high-impact event.
The woman in this case survived but only after urgent intervention and a low course of speech therapy and physical rehabilitation. Her stroke left lasting deficits, but she regained speech and mobility with time. The source of her stroke was something no one expected. Not a clot from her heart, but a small tear in a vertebral artery. Likely caused by an everyday position that most of us wouldn't think twice about.