Spreading depolarizations, migraine and ischemia: A detrimental triangle in subarachnoid hemorrhage and ischemic stroke?

Author(s):
Hamming, A.M.
Published
2020
Publication type
Doctoral Thesis

Abstract

This thesis is about the role of spreading depolarization (SD) in subarachnoid hemorrhage (SAH) as explained in Chapter 1.

Chapters 2 and 3 use a rat model of SAH, SD induction and SD-inhibitor valproate. They suggest a direct association between SD and lesion growth after experimental SAH, which can be counteracted by valproate.

Chapter 4 explores the application of MRI techniques to monitor SD induced in rats. Balanced-steady-state-free-precession (b-SSFP) captures more detail than gradient-echo MRI. Diffusion-weighted multi-spin-echo (DT2) scans allowed for simultaneous recording of hemodynamic and diffusion changes.

Chapter 5 describes a trend towards less DCI in SAH patients using SD-inhibiting drugs, but that did not result in a better clinical outcome. This suggests a possible protective effect of SD-inhibition on DCI but an unclear possible detrimental effect on other factors that affect clinical outcome. Chapter 6 found, in an ischemic stroke cohort, no statistically significant differences in the percentage of incomplete circles of Willis between migraine and non-migraine patients. Chapter 7 provides a general discussion of the findings from chapter 2-6.

Spreading depolarization (SD)Cortical spreading depressionSubarachnoid hemorrhage (SAH)ValproateMagnetic resonance imagingBalanced-steady-state-free-precession (b-SSFP)Diffusion-weighted multi-spin-echo (DT2)Delayed cerebral ischemia (DCI)Circles of WillisMigraine
Defense date
2020-11-12
Language
English
Supervisor(s)
Wermer, M.J.H.; Dijkhuizen, R.M.; Ferrari M.D.
Committee member(s)
Peul, W.C.; Hofmeijer, J.; Rinkel, G.J.E.; Weerd, L. van der
Qualification
Ph.D.
Degree granting institution
Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University, Leiden
hdl
1887/137968
ISBN(s)
9789082344073