Portal de Periódicos da CAPES

Bilateral Earlobe Crease (Frank’s Sign) and Multifocal Vascular Disease

2022; Lippincott Williams & Wilkins; Volume: 53; Issue: 11 Linguagem: Inglês

10.1161/strokeaha.122.039102

1524-4628

Elizabeth Carreon-Camarena, Juan Carlos Ayala-Alvarez, José Luis Ruíz‐Sandoval, Amado Jiménez‐Ruiz,

Facial Rejuvenation and Surgery Techniques

HomeStrokeVol. 53, No. 11Bilateral Earlobe Crease (Frank's Sign) and Multifocal Vascular Disease Free AccessCase ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCase ReportPDF/EPUBBilateral Earlobe Crease (Frank's Sign) and Multifocal Vascular Disease Elizabeth Carreon-Camarena, Juan Carlos Ayala-Alvarez, Jose Luis Ruiz-Sandoval and Amado Jimenez-Ruiz Elizabeth Carreon-CamarenaElizabeth Carreon-Camarena https://orcid.org/0000-0002-7815-2413 Stroke Clinic, Department of Neurology Hospital Civil de Guadalajara Fray Antonio Alcalde Guadalajara, Jalisco. , Juan Carlos Ayala-AlvarezJuan Carlos Ayala-Alvarez https://orcid.org/0000-0003-4966-4708 Stroke Clinic, Department of Neurology Hospital Civil de Guadalajara Fray Antonio Alcalde Guadalajara, Jalisco. , Jose Luis Ruiz-SandovalJose Luis Ruiz-Sandoval https://orcid.org/0000-0002-0482-7916 Stroke Clinic, Department of Neurology Hospital Civil de Guadalajara Fray Antonio Alcalde Guadalajara, Jalisco. and Amado Jimenez-RuizAmado Jimenez-Ruiz Correspondence to: Amado Jimenez-Ruiz, MD, Hospital No. 278, Centro Barranquitas, 44280, Guadalajara, Jalisco. Email E-mail Address: [email protected] https://orcid.org/0000-0002-0257-3107 Stroke Clinic, Department of Neurology Hospital Civil de Guadalajara Fray Antonio Alcalde Guadalajara, Jalisco. Originally published24 Aug 2022https://doi.org/10.1161/STROKEAHA.122.039102Stroke. 2022;53:e479–e480Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: August 24, 2022: Ahead of Print A 66-year-old male presented with acute chest pain. He had a history of noncontrolled hypertension without other known comorbidities. On examination, we noticed a bilateral earlobe crease (Frank's sign; Figure 1). The electrocardiogram was relevant for DII, DIII, AVF, and ST-elevation (Figure 2).Download figureDownload PowerPointFigure 1. Left earlobe crease (Frank's sign).Download figureDownload PowerPointFigure 2. Twelve-lead EKG showing acute ST-elevation consistent with a diagnosis ofinferior acute myocardial infarction.After intravenous thrombolysis with Alteplase, the patient presented a hypertensive crisis and developed a comatose state due to hemorrhagic pontine stroke (Figure 3A through 3C). The patient died due to multiorgan failure and sepsis.Download figureDownload PowerPointFigure 3. A–C, Unenhanced computed tomography revealing a pontine hypertensive hemorrhage with medullary extension.Frank's sign is a diagonal crease in the earlobe extending from the tragus across the lobule to the auricle. Its true incidence and prevalence in the general population is unknown, but has been associated with cerebrovascular and coronary artery disease.1–3Cirera-Sanchez, et al4 found a prevalence of 8% of concomitant hemorrhagic stroke and Frank's sign (P<0.05).Frank's sign might be an overlooked clinical finding to screen patients for the early diagnosis and treatment of multifocal vascular disease.Key PointBilateral earlobe crease (Frank's sign) may be associated with multifocal arterial disease.Article InformationDisclosures None.FootnotesFor Disclosures, see page e479.Correspondence to: Amado Jimenez-Ruiz, MD, Hospital No. 278, Centro Barranquitas, 44280, Guadalajara, Jalisco. Email dr.amadojimenez@gmail.comReferences1. 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. doi: 10.1371/journal.pone.0261080CrossrefGoogle Scholar2. 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. 2020; 41:257–262. doi: 10.1007/s10072-019-04080-2CrossrefGoogle Scholar3. 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. doi: 10.1016/j.amjmed.2017.03.059CrossrefGoogle Scholar4. Rodríguez-López C, Garlito-Díaz H, Madroñero-Mariscal R, Sánchez-Cervilla PJ, Graciani A, López-Sendón JL, López-de- Sá E. Earlobe crease shapes and cardiovascular events.Am J Cardiol. 2015; 116:286–293. doi: 10.1016/j.amjcard.2015.04.023CrossrefGoogle Scholar eLetters(0) eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate. Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page. Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetails November 2022Vol 53, Issue 11 Advertisement Article Information Metrics © 2022 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.122.039102PMID: 36000396 Originally publishedAugust 24, 2022 PDF download Advertisement Subjects Acute Coronary Syndromes High Blood Pressure Hypertension Intracranial Hemorrhage Myocardial Infarction