Relationship between Diagonal Earlobes Crease and Ischemic Stroke Risk

Authors

  • Kanokporn Temeecharoentaworn Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Integrated Epilepsy Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
  • Somsak Tiamkao Integrated Epilepsy Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand https://orcid.org/0000-0001-5178-478X
  • Kamonwon Ienghong Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand https://orcid.org/0000-0003-0328-4128
  • Lap Woon Cheung Department of Accident and Emergency, Princess Margaret Hospital, Kowloon, Hong Kong; Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
  • Korakot Apiratwarakul Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand https://orcid.org/0000-0002-1984-0865

DOI:

https://doi.org/10.3889/oamjms.2022.8719

Keywords:

Diagonal earlobe crease, Ischemic stroke, Frank’s sign

Abstract

BACKGROUND: Diagonal earlobe crease has been shown as the association between atherosclerotic disease.

AIM: To examine the relationship between diagonal earlobes crease (DELC) and ischemic stroke.

METHODS: This prospective study recruited 175 consecutive acute ischemic stroke patients admitted to the Stroke Unit of Srinagarind Hospital, Faculty of Medicine, Khon Kaen University between May 2021 and August 2021. Clinical data included age, gender, underlying disease, clinical presentation, vital signs, brain computed tomography and DELC assessed for both ears.  The study was approved by the Human Ethics Research Committee of Khon Kaen University, Thailand.

RESULTS: patients were assessed on clinical presentation and brain computed tomography (CT) findings. There were 31 patients with transient ischemic attacks (17.7% of the patients) and 144 patients with cerebral infarction (82.3%). In all participants were male 58.9% and 72 were female (41.1%). The top three clinical presentations were hemiparesis (29.6%), dysarthria (27.0%), and facial palsy (17.5%). One hundred and thirty-one patients (74.9%) had underlying diseases; hypertension (24.2%), diabetic mellitus (14.4%), atrial fibrillation (4.9%), chronic kidney disease (2.0%), dyslipidemia (8.0%), valvular heart disease (2.3%), coronary heart disease (2.6%), previous stroke (8.1%), and other diseases (8.4%). Only 44 patients (25.1%) had no underlying disease. Frank’s sign (DELC) was present in only 13 patients (7.4%). There were similar proportions of major underlying conditions, hypertension, and diabetic mellitus for both groups, and no differences apparent for gender or old age. On CT scans both DELC and non-DELC patients showed lacunar infarction as the major source of ischemic stroke. 

CONCLUSIONS: Due to our very small sample of DELC patients, we could draw no conclusions about the relationship between DELC and ischemic stroke and its predictive utility as a biomarker for ischemic stroke.  Given the much higher proportions of DELC patients reported in international literature we raise the possibility of physiological, genetic, or ethnic differences in Thai, or Asian samples, for future research.

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References

Chatterjee K, Ghosh A, Sengupta RS. Diagonal earlobe crease: Frank’s sign in metabolic syndrome. J Pract Cardiovasc Sci. 2016;2(1):67. https://doi.org/10.4103/2395-5414.182982 DOI: https://doi.org/10.4103/2395-5414.182982

Sousa ED, Fernandes VL, Goel HC, Naik K, Pinto NM. A study on the prevalence of diagonal earlobe crease in patients with cardiovascular disease and diabetes mellitus. Indian J Otol. 2020;26(1):9-14. https://doi.org/10.4103/indianjotol.INDIANJOTOL_117_18

Pacei V, 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(2):257-62. https://doi.org/10.1007/s10072-019-04080-2 PMid:31641899 DOI: https://doi.org/10.1007/s10072-019-04080-2

Stoyanov G, Dzhenkov D, Petkova L, Sapundzhiev N, Georgiev S. The histological basis of Frank’s sign. Head Neck Pathol. 2021;15(2):402-7. https://doi.org/10.1007/s12105-020-01205-4. PMid:32712879 DOI: https://doi.org/10.1007/s12105-020-01205-4

Koyama T, Watanabe H, Ito H. The association of circulating inflammatory and oxidative stress biomarker levels with diagonal earlobe crease in patients with atherosclerotic diseases. J Cardiol. 2016;67(4):347-51. https://doi.org/10.1016/j.jjcc.2015.06.002 PMid:26162942 DOI: https://doi.org/10.1016/j.jjcc.2015.06.002

Nazzel S, Hijazi B, Khalila L, Blum A. Diagonal earlobe crease (Frank’s sign): A Predictor of cerebral vascular events. Am J Med. 2017;130(11):1324-41. https://doi.org/10.1016/j.amjmed.2017.03.059 PMid:28460854 DOI: https://doi.org/10.1016/j.amjmed.2017.03.059

Patel V, Champ C, Andrews PS, Gostelow BE, Gunasekara NP, Davidson AR. Diagonal earlobe creases and atheromatous disease: A postmortem study. J R Coll Physicians Lond. 1992;26(3):274-7. PMid:1404022

Elawad A, Albashir D. Frank’s sign: Dermatological marker for coronary artery disease. Oxf Med Case Report. 2021;9(1):367-8. https://doi.org/10.1093/omcr/omab089 PMid:34557307 DOI: https://doi.org/10.1093/omcr/omab089

Higuchi Y, Maeda T, Guan J, Oyama J, Sugano M, Makino N. Diagonal earlobe creases are associated with shorter telomer in male Japanese patients with metabolic syndrome: A pilot study. Circ J. 2009;73(2):272-9. https://doi.org/10.1253/circj.cj-08-0267 PMid:19060421 DOI: https://doi.org/10.1253/circj.CJ-08-0267

Ramdurg P, Srinivas N, Puranik S, Sande A. Frank’s sign a clinical indicator in the detection of coronary heart disease among dental patients: A case control study. J Indian Acad Oral Med Radiol. 2018;30(3):241-6. https://doi.org/10.4103/jiaomr.jiaomr_90_18

Shoenfeld Y, Mor R, Weinberger A, Avidor, Pinkhas J. Diagonal ear lobe crease and coronary risk factors. J Am Geriatr Soc. 1980;28(4):184-7. https://doi.org/10.1111/j.1532-5415.1980.tb00514.x PMid:7365179 DOI: https://doi.org/10.1111/j.1532-5415.1980.tb00514.x

Kamal R, Kausar K, Qavi AH, Minto MH, Ilyas F, Assad S, et al. Diagonal earlobe crease as a significant marker for coronary artery disease: A case-control study. Cureus. 2017;9(2):e1013. https://doi.org10.7759/cureus.1013 PMid:28331775 DOI: https://doi.org/10.7759/cureus.1013

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Published

2022-02-23

How to Cite

1.
Temeecharoentaworn K, Tiamkao S, Ienghong K, Cheung LW, Apiratwarakul K. Relationship between Diagonal Earlobes Crease and Ischemic Stroke Risk. Open Access Maced J Med Sci [Internet]. 2022 Feb. 23 [cited 2024 Mar. 28];10(E):269-73. Available from: https://oamjms.eu/index.php/mjms/article/view/8719

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Funding data

  • Khon Kaen University
    Grant numbers Integrated Epilepsy Research Group, Srinagarind Hospital, Faculty of Medicine

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