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Xu J, Wang L, Zhang C, Wang J, Zheng D, Huang Y, Zhang X, You S, Cao Y, Liu CF. The prognostic value of deep earlobe creases in patients with acute ischemic stroke. Front Cardiovasc Med 2023; 10:1096044. [PMID: 37324621 PMCID: PMC10266351 DOI: 10.3389/fcvm.2023.1096044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 05/09/2023] [Indexed: 06/17/2023] Open
Abstract
Background and purpose Data on earlobe crease (ELC) among patients with acute ischemic stroke (AIS) are limited. Here, we determined the frequency and characteristics of ELC and the prognostic effect of ELC among AIS patients. Methods A total of 936 patients with acute AIS were enrolled during the period between December 2018 and December 2019. The patients were divided into those without and with ELC, unilateral and bilateral ELC, and shallow and deep ELC, according to the photographs taken of the bilateral ears. Logistic regression models were used to estimate the effect of ELC, bilateral ELC, and deep ELC on poor functional outcomes at 90 days (a modified Rankin Scale score ≥2) in AIS patients. Results Among the 936 AIS patients, there were 746 (79.7%) patients with ELC. Among patients with ELC, there were 156 (20.9%) patients with unilateral ELC and 590 (79.1%) with bilateral ELC and 476 (63.8%) patients with shallow ELC and 270 (36.2%) with deep ELC. After adjusting for age, sex, baseline NIHSS score, and other potential covariates, patients with deep ELC were associated with a 1.87-fold [odds ratio (OR) 1.87; 95% confidence interval (CI), 1.13-3.09] and 1.63-fold (OR 1.63; 95%CI, 1.14-2.34) increase in the risk of poor functional outcome at 90 days in comparison with those without ELC or shallow ELC. Conclusion ELC was a common phenomenon, and eight out of ten AIS patients had ELC. Most patients had bilateral ELC, and more than one-third had deep ELC. Deep ELC was independently associated with an increased risk of poor functional outcome at 90 days.
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Affiliation(s)
- Jiaping Xu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Lixuan Wang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Neurology, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Chunqing Zhang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiayun Wang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Neurology, Qinghai University Affiliated Hospital, Xining, China
| | - Danni Zheng
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Yaqian Huang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xia Zhang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Shoujiang You
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yongjun Cao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Institutes of Neuroscience, Soochow University, Suzhou, China
| | - Chun-Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Institutes of Neuroscience, Soochow University, Suzhou, China
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Sánchez-Cirera L, Bashir S, Ciscar A, Marco C, Cruz V, Terceño M, Silva Y, Serena J. Prevalence of the Frank's sign by aetiopathogenic stroke subtype: A prospective analysis. PLoS One 2021; 16:e0261080. [PMID: 34910754 PMCID: PMC8673637 DOI: 10.1371/journal.pone.0261080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/23/2021] [Indexed: 11/19/2022] Open
Abstract
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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Affiliation(s)
- Laura Sánchez-Cirera
- Fellow of Neurology, Stroke Unit, Department of Neurology, Hospital Universitary Doctor Josep Trueta de Girona, Girona, Spain
| | - Saima Bashir
- Neurologist, Stroke Unit, Department of Neurology, Hospital Universitary Doctor Josep Trueta de Girona, Institut d’Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, Spain
| | - Adina Ciscar
- Student of Medicine, Medicine Faculty, University of Girona, Girona, Spain
| | - Carla Marco
- Neurologist, Stroke Unit, Department of Neurology, Hospital Universitary Doctor Josep Trueta de Girona, Institut d’Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, Spain
| | - Verónica Cruz
- Nurse of Neurology, Stroke Unit, Department of Neurology, Hospital Universitary Doctor Josep Trueta de Girona, Girona, Spain
| | - Mikel Terceño
- Neurologist, Stroke Unit, Department of Neurology, Hospital Universitary Doctor Josep Trueta de Girona, Institut d’Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, Spain
| | - Yolanda Silva
- Neurologist, Stroke Unit, Department of Neurology, Hospital Universitary Doctor Josep Trueta de Girona, Institut d’Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, Spain
| | - Joaquín Serena
- Stroke Unit, Department of Neurology, Hospital Universitary Doctor Josep Trueta de Girona, Institut d’Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, Spain
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Sekiguchi A, Inoue Y, Yamazaki S, Uchiyama A, Ishikawa O, Kuribayashi S, Uraoka T, Hara K, Yamaguchi K, Maeno T, Uchida M, Koyama H, Motegi SI. Prevalence and clinical characteristics of earlobe crease in systemic sclerosis: Possible association with vascular dysfunction. J Dermatol 2020; 47:870-875. [PMID: 32424835 DOI: 10.1111/1346-8138.15400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022]
Abstract
Patients with systemic sclerosis (SSc) develop various vasculopathy-induced vascular disorders such as Raynaud's phenomenon, abnormal nail-fold capillaries, persistent digital ischemia, digital ulcers (DU), and sometimes develop renal crisis and pulmonary artery hypertension (PAH), affecting prognosis. Earlobe crease (ELC), also known as Frank's sign, is a wrinkle extending from the tragus to the outer border of the earlobe and is generally recognized as the sign of cardiovascular events. However, no previous study analyzed the association between ELC and SSc. In this study, we examined the prevalence and clinical characteristics of ELC in SSc patients. We analyzed 145 Japanese SSc patients and found that the prevalence of ELC in SSc patients was 23.4% (43/145), similar to that previously reported in the general population without SSc. Using univariate analysis, we found that SSc patients with ELC were characterized by old age, high incidence of DU, ILD and PAH, and high complication of coronary artery diseases (CAD) compared with SSc patients without ELC. In multivariate analysis, ELC was significantly associated with old age and incidence of DU. PAH tended to correlate with ELC without statistical significance. These results suggest that ELC may be associated with vascular disorders in SSc patients. This is the first report concerning the prevalence and clinical characteristics of ELC in patients with SSc. ELC is very easy to detect in clinical practice and helps physicians to identify SSc patients at risk of developing vascular disorders such as DU and PAH.
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Affiliation(s)
- Akiko Sekiguchi
- Departments of, Department of, Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yuta Inoue
- Departments of, Department of, Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sahori Yamazaki
- Departments of, Department of, Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akihiko Uchiyama
- Departments of, Department of, Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Osamu Ishikawa
- Departments of, Department of, Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Shiko Kuribayashi
- Department of, Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toshio Uraoka
- Department of, Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kenichiro Hara
- Department of, Respiratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kouichi Yamaguchi
- Department of, Respiratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toshitaka Maeno
- Department of, Respiratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Mitsuo Uchida
- Department of, Public Health, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroshi Koyama
- Department of, Public Health, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sei-Ichiro Motegi
- Departments of, Department of, Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
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Pacei F, Bersano A, Brigo F, Reggiani S, Nardone R. Diagonal earlobe crease (Frank's sign) and increased risk of cerebrovascular diseases: review of the literature and implications for clinical practice. Neurol Sci 2019; 41:257-262. [PMID: 31641899 DOI: 10.1007/s10072-019-04080-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/16/2019] [Indexed: 02/07/2023]
Abstract
Diagonal earlobe crease (DELC) or Frank's sign is a diagonal crease in the earlobe that extends diagonally from the tragus to the edge of the auricle with an angle of approximately 45°. Although its presence increases with advancing age, several studies have shown an independent association between DELC and cardiovascular diseases as well as peripheral vascular diseases. DELC has also been demonstrated to increase the risk of cerebrovascular events (mostly ischaemic stroke), probably through atherosclerotic mechanisms. A systematic literature search was conducted using PubMed and Embase to identify studies investigating the relationship between DELC and the occurrence of cerebrovascular diseases. We identified 5 articles (1469 subjects included). Since the presence of DELC can be easily evaluated, patients with the Frank's sign should undergo a diagnostic workup to detect vascular risk factors and implement preventative therapies.
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Affiliation(s)
- Federico Pacei
- Department of Neurology, ASST Nord Milano, Ospedale Bassini, Cinisello Balsamo, Milan, Italy
| | - Anna Bersano
- Division Cerebrovascular Disease Unit, IRCCS Foundation "C. Besta", Neurological Institute, Milan, Italy
| | - Francesco Brigo
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy.,Division of Neurology, Franz Tappeiner Hospital, Via Rossini, 5, 39012, Merano, BZ, Italy
| | - Stefano Reggiani
- Department of Neurology, ASST Nord Milano, Ospedale Bassini, Cinisello Balsamo, Milan, Italy
| | - Raffaele Nardone
- Division of Neurology, Franz Tappeiner Hospital, Via Rossini, 5, 39012, Merano, BZ, Italy. .,Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.
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Abstract
Clinicians have attempted to find early preclinical physical diagnosis signs to detect vascular diseases at the preclinical stage and to prevent clinical deterioration in time. An interesting example of such signs is the Frank sign, which was first described by Dr Sonders T. Frank in 1973. Our goal was to summarize the clinical trials and observational studies that had examined the association between the Frank sign and cardiovascular diseases. Summarizing the 57 studies we found showed that this association could be used for early diagnosis of coronary and vascular diseases in the preclinical stage and that they were found in different populations around the world. Autopsy studies also found a strong association between the Frank sign and cardiovascular causes of death in both sexes. Cardiovascular causes of death included ischemic and hypertensive heart disease, calcific valvular stenosis, ruptured dissecting aneurysm of the thoracic aorta, and ruptured atheromatous aneurysm of the abdominal aorta. The Frank sign was correlated with increased intima-media thickness and stroke and was found in patients with peripheral vascular disease and with cardiovascular risk factors. The Frank sign could serve as a physical sign to help clinicians diagnose cardiovascular diseases.
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Affiliation(s)
- Saleh Nazzal
- From the Department of Medicine, Baruch Padeh Poria Medical Center, Azrieli Faculty of Medicine, Bar Ilan University, Israel
| | - Arnon Blum
- From the Department of Medicine, Baruch Padeh Poria Medical Center, Azrieli Faculty of Medicine, Bar Ilan University, Israel
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Nazzal S, Hijazi B, Khalila L, Blum A. Diagonal Earlobe Crease (Frank's Sign): A Predictor of Cerebral Vascular Events. Am J Med 2017; 130:1324.e1-1324.e5. [PMID: 28460854 DOI: 10.1016/j.amjmed.2017.03.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 11/25/2022]
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.
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Affiliation(s)
- Saleh Nazzal
- Department of Medicine, Baruch Padeh Poria Medical Center, Faculty of Medicine in the Galilee, Bar-Ilan University, Tiberias, Lower Galilee, Israel
| | - Basem Hijazi
- Department of Medicine, Baruch Padeh Poria Medical Center, Faculty of Medicine in the Galilee, Bar-Ilan University, Tiberias, Lower Galilee, Israel
| | - Luai Khalila
- Department of Medicine, Baruch Padeh Poria Medical Center, Faculty of Medicine in the Galilee, Bar-Ilan University, Tiberias, Lower Galilee, Israel
| | - Arnon Blum
- Department of Medicine, Baruch Padeh Poria Medical Center, Faculty of Medicine in the Galilee, Bar-Ilan University, Tiberias, Lower Galilee, Israel.
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