Diagonal Earlobe Crease (Frank's Sign): A Predictor of Cerebral Vascular Events

Saleh Nazzal, Basem Hijazi, Luai Khalila, Arnon Blum

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


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.

Original languageEnglish
Pages (from-to)1324.e1-1324.e5
JournalAmerican Journal of Medicine
Issue number11
StatePublished - Nov 2017

Bibliographical note

Publisher Copyright:
© 2017 Elsevier Inc.


  • Cerebrovascular accident
  • Frank's sign
  • Transient ischemic attack


Dive into the research topics of 'Diagonal Earlobe Crease (Frank's Sign): A Predictor of Cerebral Vascular Events'. Together they form a unique fingerprint.

Cite this