Vertebro-basilary insufficiency and Beauty Parlor Syndrome- Individualised therapeutic options

Introduction: Vertebrobasilar insufficiency is a com-mon condition in general population yet underdiagno-sed due to clinical complexity. The syndrome is cha-racterised by transitory ischemia in the vertebrobasilar teritory due to local hemodynamic changes. The appea-rence of specific clinical manifestations in postural and head changes is named Beauty Parlor Syndrome.

Methods: We presant the case of a 67 year old fema-le patient, with multiple cardiovascular risk factors (hypertension, dyslipidemia, obesity), admitted in the cardiology clinic for daily episodes of headache and ata-xia for one month. The symptoms developed suddenly, with an transitory ischemic stroke manifested with di-sartria, diplopia, disphagia and ataxia after prolongued head hyperextension at a beauty salon. The symptoms resolved in 30 minutes. At admission, the patient is hemodinamically stable (BP=125/80 mmHg), in sinus rythm 80/min, without cardiovascular murmurs. The patient undergoes the following medical treatment: atorvastatin 20 mg/day, aspirin 75 mg/day and perin-dopril 5 mg/day.

Results: Work-up tests reveal mild hypercholestero-lemia (LDLcholesterol=90mg/dL), normal left ventri-cle dimensions, with normal kinetics, with preserved global systolic function (LVEF=60%), and the absence of paroxistic atrial fibrilation at Holter ECG. We per-formed a Schellong test which reproduced neruologic symptoms without any variations in blood pressure. We evaluated cervical vessel with digital substraction angiography and observed occlusion of right internal carotid artery and 95% ostial stenosis of left vertebral artery. The specific neurological symptoms and severe atherosclerotic disease of the cervical vessels confirm the diagnosis of vertebrobasilar insufficiency. Due to severity of the clinical manifestations, our Heart Team advised for angioplasty of the vertebral artery. Percu-taneous angioplasty of the ostium of the left vertebral artery was performed without any periprocedural com-plications. Short term evolution was favourable, with complete remission of symptoms at the 24h postpro-cedural Schellong test. At 3 months, the patient was asymptomatic, and doppler echography revealed a per-meable vertebral stent.

Conclusions: Vertebrobasilar insufficiency is a com-mon disease, especially in the elderly, and rarely pre-sents with a specific terapeutic option. In our case, in-terventional approach determined complete resolution of symptoms with favorable short-term prognosis.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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