June 24, 2019 e-Pearl of the Week: Frank's sign
Frank's sign
Frank’s sign appears as an earlobe crease extending 45 degrees diagonally from the tragus to the outer border of the lobe.1 It presents as a marker of subclinical atherosclerosis, leading to cardiovascular or cerebrovascular disease.2,3 Pathophysiology may include intimal thickening leading to microvascular ischemia to earlobe end arterioles. Correlations with cerebrovascular disease have been observed via carotid ultrasound with a sensitivity of 73% and specificity of 70%.1 Presence of Frank’s sign with symptomatic carotid disease should prompt physicians to evaluate for carotid atherosclerotic disease.
References
1. Glavic J, Cerimagic D, Lovrenic-Huzjan A., Vukovic V., Demarin V. Frank’s sign as a risk factor for cerebrovascular disease. Atherosclerosis 2008: 196;477–478.
2. Nazzal S., Hijazi B., Khalila L., Blum A. Diagonal Earlobe Crease (Frank’s Sign): A Predictor of Cerebral Vascular Events. The American Journal of Medicine 2017:130;1324.e1–1324.e5
3. Celik S., Erdogan T., Gedikli O., Kiris A., Erem C. Diagonal ear-lobe crease is associated with carotid intima-media thickness in subjects free of clinical cardiovascular disease. Atherosclerosis 2007;192: 428–431.
Submitted by Joshua Christy, Medical Student, Windsor University School of Medicine, and Faisal Khan, MD, DABSM, DABPN, Consultant Neurologist, Sugar Land Neurology and Sleep, Texas
Joshua Christy and Dr. Khan report no disclosures.