Diagonal Earlobe Crease (Frank's Sign), a New Clinical Sign to Look for in Patients with Intracranial Aneurysms?: Patient Series

Introduction: Overall intracranial aneurysms produce very few clinical signs that can be determined as risk factors (initiation, growth, and rupture). Most clinical traits are seen when there is a rupture of the intracranial aneurysm and it is already too late. Diagonal earlobe crease (DELC), also known as Frank's sign, was first described by Sonders T. Frank in 1973. He defined a deep crease at a 45-degree angle on the lobule of the ear and associated it with heart disease.
During the patient's general physical examination with ruptured and unruptured aneurysms, our team identified all of the patients exhibiting this previously mentioned easily recognizable clinical sign.

Methods: Our team describes 16 patients with ruptured and unruptured intracranial aneurysms who underwent physical examination during their general assessment. All had Diagonal Earlobe Creases (Frank’s sign).

Results: Out of the 16 patients, we observed a mean age of 52.375, with a standard deviation of 10.57. When observing and specifying DELC characteristics we discerned that 11 were complete (67%), 6 incomplete (37%), 13 deep (81%), 4 superficial (25%), 12 bilateral (75%), 2 unilateral that only involved the right ear (12%), 2 unilateral that only involved the left ear (12%). Image studies detailed the involvement of 2 anterior cerebral artery (ACA) aneurysms (12%), 3 ACoA aneurysms (18%), 6 MCA aneurysms (37%), 5 ICA aneurysms (31%), and 1 basilar aneurysm (6%), 3 cases had more than one aneurysm (18%). Additionally, 11 cases were unruptured aneurysms (67%) and 5 unruptured aneurysms (31%).

Conclusion : We highly consider that DELC will be a common and easily recognizable sign in patients with ruptured and unruptured intracranial aneurysms due to the profound similarities in pathophysiological atherosclerotic changes. This could be a helpful tool to further scrutinize in support of detecting the formation, elongation, and rupture of intracranial aneurysms.