Diagonal Earlobe Crease (Frank's Sign): A Predictor of Cerebral Vascular Events

Nazzal, Saleh; Hijazi, Basem; Khalila, Luai; Blum, Arnon

doi:10.1016/j.amjmed.2017.03.059

Cited by 27 publications

(31 citation statements)

References 19 publications

(29 reference statements)

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“…White-matter lesions accompanied by cognitive decline are also considered to be linked to activation of platelet function [100]. In contrast to these factors, diagonal ear lobe crease (DELC) has been proposed as a marker for atherosclerotic disease [101,102]. Interestingly, DELC was more frequently found in persons with VCI than in cognitionnormal persons.…”

Section: Other Vascular Risk Factors For Wmhs-related Cognitive Deficitmentioning

confidence: 99%

Role of White Matter Hyperintensities and Related Risk Factors in Vascular Cognitive Impairment: A Review

et al. 2021

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White matter hyperintensities (WMHs) of presumed vascular origin are one of the imaging markers of cerebral small-vessel disease, which is prevalent in older individuals and closely associated with the occurrence and development of cognitive impairment. The heterogeneous nature of the imaging manifestations of WMHs creates difficulties for early detection and diagnosis of vascular cognitive impairment (VCI) associated with WMHs. Because the underlying pathological processes and biomarkers of WMHs and their development in cognitive impairment remain uncertain, progress in prevention and treatment is lagging. For this reason, this paper reviews the status of research on the features of WMHs related to VCI, as well as mediators associated with both WMHs and VCI, and summarizes potential treatment strategies for the prevention and intervention in WMHs associated with VCI.

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Section: Other Vascular Risk Factors For Wmhs-related Cognitive Deficitmentioning

confidence: 99%

Role of White Matter Hyperintensities and Related Risk Factors in Vascular Cognitive Impairment: A Review

et al. 2021

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“…This possibility would explain why the independent association between ELC and cardiovascular events was not significant in the present study. Although the mechanisms leading to the development of ELC are still unclear, previous studies in non-dialysis populations have shown ELC to be associated with well-known traditional cardiovascular risk factors, such as hypertension (9,(12)(13)(14), smoking (9,13,22), obesity (22), and diabetes (12,14,23). Hemodialysis patients have a higher prevalence of these traditional factors, as well as several non-traditional risk factors, such as anemia, hyperhomocysteinemia, chronic kidney disease-mineral bone disorder (CKD-MBD), oxidative stress, malnutrition, and chronic inflammation, than non-dialysis patients (24).…”

Section: Discussionmentioning

confidence: 99%

“…The earlobe crease (ELC), also called Frank's sign (7), is a wrinkle extending from the tragus to the outer border of the earlobe. Several studies in non-dialysis populations have described ELC as a predictor of future CVD, including coronary heart disease (8)(9)(10)(11), cerebrovascular disease (12), and peripheral vascular diseases (13,14). The presence of ELC, which can be assessed easily without any test, might function as a visible prompt for both physicians and patients to screen for CVD.…”

Section: Introductionmentioning

confidence: 99%

The Association between Earlobe Creases and Cardiovascular Events in Japanese Hemodialysis Patients: A Prospective Cohort Study

Wakasugi

Nagai²,

Yokota

et al. 2020

Intern. Med.

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Objective The earlobe crease, a wrinkle extending from the tragus to the outer border of the earlobe, is a well-known surrogate marker for a high risk of cardiovascular disease. However, information is lacking about its association with cardiovascular events among hemodialysis patients, who already have an increased risk of cardiovascular disease. We tested the hypothesis that earlobe creases are independently associated with the risk of cardiovascular events among Japanese hemodialysis patients. Methods This prospective cohort study followed 247 adult hemodialysis patients with no history of cardiovascular disease for 4 years. The presence of earlobe creases was defined by two researchers using photos of patients' earlobes on both sides while blinded to one another's assessments and clinical data. The primary outcome was defined as the first fatal or nonfatal cardiovascular event (myocardial infarction, ischemic or hemorrhagic stroke, or peripheral vascular disease requiring aortic or peripheral vascular bypass surgery or below-or above-the-knee amputation). A Fine-Gray competing risks regression model was used to examine the association between earlobe creases and cardiovascular events. Results During the 4-year follow-up period, 43 patients suffered cardiovascular events. After the competing risk of non-cardiovascular death was accounted for, patients with earlobe creases had an increased cumulative incidence of cardiovascular events compared to those without earlobe creases (subhazard ratio =2.04, 95% confidence interval: 1.09 to 3.82). This association was no longer significant after adjusting for age. Conclusion Earlobe creases were not independently associated with cardiovascular events among Japanese hemodialysis patients, suggesting that these marks are simply indicative of advanced age.

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“…Some studies have described an association between Frank’s sign and the presence of diabetes, hypertension [ 11 , 13 ], myocardial infarction and coronary artery disease [ 6 , 7 ] in patients of both sexes. According to these studies, this easily identifiable sign could be valuable in the screening of patients at high risk of having silent coronary artery disease.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of the Frank’s sign by aetiopathogenic stroke subtype: A prospective analysis

et al. 2021

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Background and purpose The Frank’s sign is a diagonal earlobe crease running from the tragus to the edge of the auricle at an angle of 45°. Many studies have associated this sign with coronary artery disease and some with cerebrovascular disease. The objective of this study was to analyse the prevalence of the Frank’s sign in patients suffering from acute stroke with a particular focus on its prevalence in each of the five aetiopathogenic stroke subtypes. Special interest is given to embolic stroke of undetermined source (ESUS), correlating the sign with clinical and radiological markers that support an underlying causal profile in this subgroup. Methods Cross-sectional descriptive study including 124 patients admitted consecutively to a stroke unit after suffering an acute stroke. The Frank’s sign was evaluated by the same blinded member of the research team from photographs taken of the patients. The stroke subtype was classified following SSS-TOAST criteria and the aetiological study was performed following the ESO guidelines. Results The Frank’s sign was present in 75 patients and was more prevalent in patients with an ischaemic stroke in comparison with haemorrhagic stroke (63.9 vs. 37.5, p<0.05). A similar prevalence was found in the different ischaemic stroke subtypes. The Frank’s sign was significantly associated with age, particularly in patients older than 70 who had vascular risk factors. Atherosclerotic plaques found in carotid ultrasonography were significantly more frequent in patients with the Frank’s sign (63.6%, p<0.05). Analysing the ESUS, we also found an association with age and a higher prevalence of the Frank’s sign in patients with vascular risk factors and a tendency to a high prevalence of atherosclerosis markers. Conclusion The Frank’s sign is prevalent in all aetiopathogenic ischaemic stroke subtypes, including ESUS, where it could be helpful in suspecting the underlying cardioembolic or atherothrombotic origin and guiding the investigation of atherosclerosis in patients with ESUS and the Frank’s sign.

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Diagonal Earlobe Crease (Frank's Sign): A Predictor of Cerebral Vascular Events

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

Cited by 27 publications

References 19 publications

Role of White Matter Hyperintensities and Related Risk Factors in Vascular Cognitive Impairment: A Review

Role of White Matter Hyperintensities and Related Risk Factors in Vascular Cognitive Impairment: A Review

The Association between Earlobe Creases and Cardiovascular Events in Japanese Hemodialysis Patients: A Prospective Cohort Study

Prevalence of the Frank’s sign by aetiopathogenic stroke subtype: A prospective analysis

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