In her role as Daenerys Targaryen (a.k.a. the "Mother of Dragons") in "Game of Thrones," actress Emilia Clarke has faced several life and death battles. But in her mind, these pale in comparison to the terrifying real-life health scare the 32-year-old actress recently revealed. In the March 21, 2019 edition of The New Yorker magazine, Clarke wrote an article telling the story of how she survived .
The first occurred shortly after finishing the first season of "Game of Thrones," in February 2011. During a work-out with a trainer, Clarke felt a headache coming on. While doing a plank, she felt "as though an elastic band were squeezing my brain. I tried to ignore the pain and push through it, but I just couldn't." She got to the locker room, where she started to vomit as the pain became worse. A "fog of unconsciousness" settled over her as she was taken by ambulance to a local hospital. An MRI revealed a subarachnoid hemorrhage, caused by a ruptured cerebral aneurysm. She was transferred to the National Hospital for Neurology and Neurosurgery in London, where she underwent a "minimally invasive" procedure called endovascular coiling.
Approximately two weeks after the procedure, Clarke developed aphasia -- the loss of ability to understand or express speech. A devastating turn for an actress who depends on speech for her livelihood! Fortunately, it resolved about a week later, and she left the hospital about a month after she had entered it. Although she still had pain and occasionally felt woozy, she had to prepare herself to return to the "Game of Thrones" set in a few weeks' time.
During her hospitalization, she had learned that there was another, smaller aneurysm on the other side of her brain. Doctors reassured her that it could "remain dormant and harmless indefinitely," but that they would just keep a watchful eye. In 2013, during a routine follow-up brain scan, doctors noted that the aneurysm had doubled in size, and recommended that it should be dealt with as soon as possible.
An attempt to repeat the endovascular coiling failed and resulted in an intracranial hemorrhage, leaving doctors no choice but to do an open skull procedure. There was a long post-op recovery, filled with pain, anxiety, and panic attacks, but she eventually healed and now says: "I am at 100%."
As part of her experience, she has become involved in a charity with partners in the U.S. and the U.K. called . The organization's goal is to provide treatment for young adults recovering from brain injury and stroke.
What you should know about brain aneurysms
Definition: A cerebral aneurysm (or brain aneurysm) is a weak or thin area on an artery in the brain that balloons or bulges out and fills with blood. Aneurysms typically form at branch points in arteries because these sections are the weakest. A bulging aneurysm can put pressure on the nerves or brain tissue. It may also burst or rupture, spilling blood into the surrounding tissue. Cerebral aneurysms can occur anywhere in the brain, but most form in the major arteries along the base of the skull.
Statistics:
- It is estimated that 6 million people in the U.S. have an unruptured brain aneurysm: that is 1 in 50 people.
- Approximately 30,000 Americans per year suffer a brain aneurysm rupture.
- Brain aneurysms can occur in anyone and at any age. They are most common in adults from the ages of 30 through 60 and are more common in women than in men (3:2 ratio).
- African-Americans and Hispanics are about twice as likely to have a brain aneurysm rupture compared to whites.
- There are almost 500,000 deaths worldwide each year caused by brain aneurysms, and half the victims are younger than 50.
- 20% of people diagnosed with a brain aneurysm have more than one aneurysm.
Symptoms: Most aneurysms are small -- about 1/8 inch to nearly one inch -- and an estimated 50-80% of all aneurysms do not rupture. Most cerebral aneurysms do not show symptoms until they either become very large or rupture.
A larger aneurysm that is steadily growing may press on tissues and nerves causing:
- pain above and behind the eye
- numbness
- weakness
- paralysis on one side of the face
- a dilated pupil in the eye
- vision changes or double vision
Ruptured aneurysm
When an aneurysm ruptures, one always experiences a sudden and extremely severe headache (e.g., the worst headache of one's life) and may also develop:
- double vision
- nausea
- vomiting
- stiff neck
- sensitivity to light
- seizures
- loss of consciousness (briefly or may be prolonged)
- cardiac arrest
Leaking aneurysm
Sometimes an aneurysm may leak a small amount of blood into the brain (called a sentinel bleed). Sentinel or warning headaches may result from an aneurysm that suffers a tiny leak, days or weeks prior to a significant rupture. However, only a minority of individuals have a sentinel headache prior to rupture.
Prognosis: About 25% of individuals whose cerebral aneurysm has ruptured do not survive the first 24 hours; another 25% die from complications within 6 months.
Approximately 15% of people with a ruptured aneurysm die before reaching the hospital. Most of the deaths are attributed to rapid and massive brain injury from the initial bleeding.
People who experience subarachnoid hemorrhage may have permanent neurological damage. Other individuals recover with little or no disability.
Treatment: Not all cerebral aneurysms require treatment. Some very small unruptured aneurysms that are not associated with any factors suggesting a higher risk of rupture may be safely left alone and monitored with MRA or CTA (CT angiogram) to detect any growth. It is important to aggressively treat any coexisting medical problems and risk factors.
Treatments for unruptured cerebral aneurysms that have not shown symptoms have some potentially serious complications and should be carefully weighed against the predicted rupture risk.
Treatment considerations for unruptured aneurysms include the type, size, and location of the aneurysm, the risk of rupture, the patient's age, health, and family medical history. Individuals can also reduce their risk by assuring blood pressure is well controlled, smoking cessation and avoidance of cocaine and other stimulant drugs.
Treatments for unruptured and ruptured cerebral aneurysms
Surgery
There are a few surgical options available for treating cerebral aneurysms. These procedures carry some risk such as possible damage to other blood vessels, the potential for aneurysm recurrence and rebleeding, and a risk of stroke.
Microvascular clipping. This procedure involves cutting off the flow of blood to the aneurysm and requires open brain surgery. A doctor will locate the blood vessels that feed the aneurysm and place a tiny, metal, clothespin-like clip on the aneurysm's neck to stop its blood supply. Clipping has been shown to be highly effective, depending on the location, size, and shape of the aneurysm. In general, aneurysms that are completely clipped do not recur.
Endovascular treatment
Platinum coil embolization. This procedure is a less invasive procedure than microvascular surgical clipping. A doctor will insert a catheter into an artery, usually the femoral artery, and thread it through the body to the brain aneurysm. Using a wire, the doctor will pass detachable coils (tiny spirals of platinum wire) through the catheter and release them into the aneurysm. The coils block the aneurysm and reduce the flow of blood into the aneurysm. The procedure may need to be performed more than once during the person's lifetime because aneurysms treated with coiling can sometimes recur.
Flow diversion devices. Other endovascular treatment options include placing a small stent (flexible mesh tube), like those placed for heart blockages, in the artery to reduce blood flow into the aneurysm. A doctor will insert a catheter into an artery, usually the femoral artery, and thread it through the body to the artery in which the aneurysm is located. This procedure is used to treat very large aneurysms and those that cannot be treated with surgery or platinum coil embolization.
(Sources: and the
Michele R. Berman, MD, and Mark S. Boguski, MD, PhD, are a wife and husband team of physicians who have trained and taught at some of the top medical schools in the country including Harvard, Johns Hopkins, and Washington University in St. Louis. Their mission is both a journalistic and educational one: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.