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Diagonal earlobe crease (Frank’s sign) and increased risk of cerebrovascular diseases: review of the literature and implications for clinical practice


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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Correspondence to Raffaele Nardone.

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Pacei, F., Bersano, A., Brigo, F. et al. Diagonal earlobe crease (Frank’s sign) and increased risk of cerebrovascular diseases: review of the literature and implications for clinical practice. Neurol Sci 41, 257–262 (2020).

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  • Diagonal earlobe crease
  • Frank’s sign
  • Cardiovascular diseases
  • Cerebrovascular diseases
  • Atherosclerosis