Frank's sign and subtypes of stroke. Could we have answers only with a glance?

Abstract

BACKGROUND: Frank’s sign is a crease in the earlobe, which has been correlated with heart disease by a mechanism of atherosclerosis and with its severity and also correlated with vascular risk factors. There are a few amount of studies that reported an association between this sign and the artery carotid intima media thickness (IMT) and only one that correlated it with stroke in general. Stroke is one of the leading causes of death worldwide and the first cause of long-term morbidity in our country, so it is important making efforts to study this pathology and how to detect it preciously. There are 5 subtypes of ischemic stroke with a different physiopathological mechanism each one. However, there are no studies that reported an association between Frank’s sign by subtypes of stroke. If Frank’s sign has been associated with an atherosclerosis diseases, the prevalence of this sign between atherotrombotic and lacunar stroke has to be higher as share the same physiopathological mechanism. Cryptogenic stroke has a lack of diagnoses in its underlying causes, the studies suggested that the main causes of them could be cardioembolism or atherotrombosis mechanisms, but the techniques that are used as routine impede the accurate diagnosis. As Frank’s sign is related to atherosclerosis, we think that Frank’s sign could help to define better the profile (atherotrombotic vs no aherotrombotic) of the patients of cryptogenic stroke to choose better some advanced diagnostic techniques in order to diagnose the real underlying cause of this subtype of stroke, and also orientate a better specific secondary preventive treatment to avoid recurrences. MAIN OBJECTIVES: The main aims of the study is to establish the prevalence of Frank’s sign in patients who suffered a stroke and, especially, to analyse the prevalence of Frank’s sign in each etiopathogenic subtype. We also will study specially the prevalence of Frank’s sing in patients with cryptogenic stroke, correlating it with the presence or absence of clinical and radiological markers to support a causal atherothrombotic or cardioembolic profile. METHODE: This protocol is a descriptive cross-sectional study to see the prevalence of Frank’s sign in the different subtypes of ischemic stroke, and describe the clinic features in those who have a cryptogenic stroke to reach the main objectives of our study. The study will include 265 patients, 53 of each of the 5 subtype of stroke, that have been hospitalized at Stroke Unit after suffering a stroke. Recruitment of participants will last 4 months. The Frank’s sign evaluation is going to be done by taking photos of the both ears of the patients in a blinded way by all the research team