Bilateral Earlobe Creases (Frank’s sign) – Marker of Coronary Artery Disease

This is an answer to the Case – A Diagonal Crease in Each Earlobe

An 84-year-old man with hypertension, diabetes, and hypercholesterolemia presented to the emergency department with a 6-hour history of visual difficulty.

Physical examination revealed a right homonymous hemianopia and no other relevant neurologic findings. A diagonal crease in each earlobe (Frank’s sign) was noted.

Urgent computed tomography revealed a subacute occipital infarction in the territory of the left posterior cerebral artery, as well as many other old ischemic lesions.

Frank’s sign was originally described as a marker of coronary artery disease, with a moderate sensitivity (approximately 48%) and specificity (approximately 88%). This sign has been subsequently associated with other cardiovascular risk factors.

The patient was treated conservatively, his course was uneventful, and he was discharged home 1 week after presentation, with persistence of the visual deficit.