COMMENTARY

Can a Hickey Really Cause a Stroke?

Robert Glatter, MD

Disclosures

September 21, 2016

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I'm Dr Robert Glatter, a member of Medscape's Emergency Medicine advisory board. I would like to make a comment about a recent news story. There are reports out of Mexico about a 17-year-old who died as a result of receiving a hickey. The exact nature of this event is unclear, but I'd like to just discuss what we've heard.

First of all, the experience of having a hickey and then dying is exceedingly rare. The question has been raised: Is it possible? In theory, it is possible. It would be, again, exceedingly rare. The mechanism is that applying trauma to the carotid artery could then cause a clot or dislodge a clot that could travel to a small artery in the brain, causing a stroke. The phenomenon of carotid artery dissection, which has been described repeatedly in the literature, can result from a vigorous cough or a sneeze, or any kind of quick manipulation of the neck sustained in a sport event,[1] or even from chiropractic manipulation.[2,3] Again, this is exceedingly rare.

The time frame could happen over hours, but it could also be days, presenting with sudden numbness of the face, tingling of the digits, weakness, and some visual complaints. In the case described, this happened relatively soon, hours after the teenager received the hickey. So, it begs the question of whether there was a congenital disorder, a genetic issue, or a connective tissue abnormality that may have predisposed this child to a stroke with him then dying so suddenly. We don't know the full details.

There are reports from 2010 in a New Zealand medical journal that detail a 44-year-old who suffered a stroke in a somewhat similar setting.[4] But I think more information will have to be necessary before we can make a complete report about this.

Parents should understand that this is rare. It's not common. Could it happen? Yes, but in theory it would be highly unlikely. Hickeys are applied to the neck, obviously, by teens and others. People should be aware that trauma from biting, from the mechanism of suction, can in theory cause trauma to a blood vessel. If people are going to do hickeys, they should be aware that they should not do this at all in the carotid anterior triangle, where the carotid artery sits. They should stay well away from this area.

I think that the take-home message is clear—that it is possible, but it would be exceedingly rare.

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