Elsevier

The American Journal of Medicine

Volume 130, Issue 11, November 2017, Pages 1324.e1-1324.e5
The American Journal of Medicine

AJM online
Clinical research study
Diagonal Earlobe Crease (Frank's Sign): A Predictor of Cerebral Vascular Events

https://doi.org/10.1016/j.amjmed.2017.03.059Get rights and content

Abstract

Background

Frank's sign was first described in 1973 by an American physician (Sonders T. Frank). It is a diagonal crease in the earlobe that starts from the tragus to the edge of the auricle in an angle of 45° in varying depths. Frank's sign was described as a predictor of future coronary heart disease and peripheral vascular diseases. The aim of the study was to examine the association between Frank's sign and the development of ischemic stroke.

Methods

This was a prospective study that enrolled consecutive patients admitted with an acute ischemic stroke. Frank's sign was tested in both ears. Clinical data included age, gender, type 2 diabetes mellitus, and hypertension. The study was approved by the institutional review board (the institutional ethics committee).

Results

A total of 241 consecutive patients who were hospitalized with an acute stroke and were eligible to take part in the study were recruited. Frank's sign was present in 190 patients (78.8%). Patients were divided according to clinical findings and the findings from brain computed tomography. There were 153 patients with transient ischemic attacks (63.6% of the patients) and 88 with cerebrovascular accidents (36.4% of the patients). A total of 112 patients with transient ischemic attacks had Frank's sign (73.2%), and 78 patients with cerebrovascular accidents had Frank's sign (88.6%), with a statistically significant difference (P <.01).

Discussion

Frank's sign could predict ischemic cerebrovascular events. Patients with classical cardiovascular risk factors had Frank's sign at a higher frequency.

Section snippets

Methods

This was a prospective study that enrolled consecutive patients (men and women) over the age of 18 years who were admitted with an acute ischemic stroke and signed a consent form to participate in the study. The diagnosis was confirmed by a senior neurologist within the first 24 hours. Medical history and physical examination were done for all patients, and data were collected also from their medical history electronic files. Frank's sign was tested in both ears. Clinical data included age,

Results

A total of 241 consecutive patients who were hospitalized with an acute stroke and were eligible to take part in the study were recruited. All had to sign a consent form before enrolment. Frank's sign was present in 190 patients (78.8%) (Table 1). Patients were divided according to clinical findings and the findings on brain computed tomography. There were 153 patients with transient ischemic attack (63.6% of the patients) and 88 with cerebrovascular accident (36.4% of the patients) (Table 2).

A

Discussion

We found that Frank's sign could predict ischemic cerebrovascular events. Patients with classic risk factors for cardiovascular events had Frank's sign at a higher frequency. We found that Frank's sign was more prevalent in patients with cerebrovascular accidents compared with patients with transient ischemic attacks. An increased rate of Frank's sign was found in patients admitted with an acute ischemic stroke and who suffered from myocardial infarction in the past. On the other hand, Frank's

Conclusion

Frank's sign is a sign found in the physical examination that predicts ischemic stroke independently and is found in patients with high risk of developing ischemic stroke even in the absence of ischemic heart disease. It is more common in older age, higher in the presence of cardiovascular risk factors such as hypertension and diabetes, and more frequent in the presence of a previous myocardial infarction or ischemic heart disease. Adding Frank's sign to the list of classic risk factors for the

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  • Cited by (0)

    Funding: None.

    Conflict of Interest: None.

    Authorship: All authors had access to data and had a role in writing the manuscript.

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