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Diagonal Earlobe Crease: A Warning Sign of Stroke

10 August 2019



Background: The diagonal earlobe crease (DELC), commonly referred to as “Frank’s sign”, was first described in 1973 by an American physician as a crease in the earlobe that originates at the tragus and runs diagonally towards the outer, lower edge. Over the past half-century, research on this dermatologic finding has found a significant correlation between the presence of a DELC and coronary artery disease (CAD). Additionally, DELC has also been associated with other risk factors associated with both CAD and stroke, which include hypertension (HTN), diabetes mellitus (DM), and age. Despite this, skepticism has led to this physical exam finding being overlooked as a predictive marker. Therefore, the purpose of this systematic review was to analyze the association between the DELC and stroke risk.

Methods: An exhaustive search of available medical literature was conducted in MEDLINE-PubMed, CINAHL, and Google Scholar, using the search terms diagonal earlobe, Frank’s sign, stroke, cerebrovascular, and cerebral. References from relevant articles were also searched. Articles were included only after screening for relevance and if eligibility criteria were met. An assessment of quality was performed using the GRADE system.

Results: The initial literature search yielded 40 articles for review. After eliminating duplicates and screening for relevant articles, a total of 2 qualifying case-control studies remained. The quality of those studies was low, however the results of both studies were consistent. These studies support a positive correlation between the presence of DELC and stroke risk.

Conclusion: This systematic review determined there was a correlation between the presence of a DELC and an increased stroke risk. Based on the findings, visual examination of patients’ earlobes should be incorporated into routine physical evaluations and clinical assessments. Doing so may provide a clinician with an additional tool to recognize and provide earlier interventions, decreasing a patient’s risk of future cerebrovascular events.


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