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... Show moreThis 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. Show less
The research described in this thesis was aimed at identifying and understanding biological mechanisms and molecular pathways involved in the pathophysiology of stroke and migraine, including the... Show moreThe research described in this thesis was aimed at identifying and understanding biological mechanisms and molecular pathways involved in the pathophysiology of stroke and migraine, including the detrimental connection between them. The thesis consists of two parts. Part 1 describes multiple experimental stroke research projects in mice in which we set out to: (I) improve the methodology of stroke research, and (II) unravel the stroke-migraine connection using diff erent research strategies, methods, and transgenic mouse models. The mouse models express human pathogenic mutations found in CADASIL, RVCL-S and FHM1 and represent the clinical spectrum of monogenic disorders linking ischemic stroke and migraine. Part 2 includes multiple clinical projects in which we set out to study a large cohort of ischemic stroke patients with and without migraine in search for means to investigate stroke characteristics and vascular pathology. Show less
The premonitory phase and early phase of both spontaneous and nitroglycerin-triggered migraine attacks were explored in this thesis, in association with clinical modulators and trigger factors.... Show moreThe premonitory phase and early phase of both spontaneous and nitroglycerin-triggered migraine attacks were explored in this thesis, in association with clinical modulators and trigger factors. Clinical research strategies, experimental designs, neuroimaging techniques and biochemical methods have revealed clinical risk factors, biochemical modulators and pharmacological triggers. Furthermore, newly discovered hypothalamus-specific alterations in metabolism and perfusion in the early phases of the migraine attack were described. Taken together, these results suggest that each migraine attack starts well before the initiation of the headache phase. The hypothalamus is postulated to have a pivotal role in the early phases of the migraine attack, and possibly affects attack susceptibility interictally as well. Show less
This thesis is about the relation between pain and language and focuses on migraine, a specific type of headache that comes in attacks. The first conclusion is that migraine is a signifier without... Show moreThis thesis is about the relation between pain and language and focuses on migraine, a specific type of headache that comes in attacks. The first conclusion is that migraine is a signifier without signified. A diagnosis of migraine only depends on the words of the patients by applying internationally agreed on criteria which form a discourse and artificially exclude ‘non-migraine headaches’. Further research-questions are whether so-defined migraine can destroy language and what is the role of time in its existence. The answers to these questions will be applied to selected novels that include protagonists with migraine. The aim of these analyses is not how migraine is being described, but how it is performed in and through these texts. The overall goal of this thesis is to come to a better understanding of the relation between migraine and language and vice versa, on the one hand by seeing the patient as text and on the other by seeing the text as patient. Show less
