Emilia Clarke, from Game of Thrones, suffered 2 strokes!

Emilia Clarke Suffered 2 Brain Aneurysms

The HBO television series Game Of Thrones is not a romantic comedy. But no matter how harrowing the Game of Thrones fictional plot line may get, it is very unlikely to match the distress that series star Emilia Clark experienced in real life, twice.

Clarke, who has played Daenerys Targaryen in the television series since 2011, penned a piece in the New Yorker describing how she had to deal with complications of her brain aneurysms in 2011 and then 2013. A brain aneurysm is otherwise known as a cerebral aneurysm, because if you want to sound smart you can call your brain a cerebrum. An aneurysm is when part of a blood vessel begins to bulge or balloon. This means that the walls of the blood vessel in that location are weakening. Imagine if a blood vessel were like a garden hose. If you were to see part of a garden hose swell like part of a balloon animal, you would concerned that the hose might begin leak or even burst in that area. That’s the same concern with an aneurysm.

Brain Aneurysm

A brain or cerebral aneurysm is when the aneurysm occurs in one of the blood vessels, usually an artery, that supplies blood to parts of the brain. A brain aneurysm bursting or rupturing is a major emergency. That is what happened to Clarke in 2011.

As she described it in her article, she was about to work out with her trainer on the morning of February 11, 2011, when she “started to feel a bad headache coming on. I was so fatigued that I could barely put on my sneakers.” Her struggles continued through the workout:

Then my trainer had me get into the plank position, and I immediately 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. I told my trainer I had to take a break. Somehow, almost crawling, I made it to the locker room. I reached the toilet, sank to my knees, and proceeded to be violently, voluminously ill. Meanwhile, the pain—shooting, stabbing, constricting pain—was getting worse. At some level, I knew what was happening: my brain was damaged.

She was eventually helped to Whittington Hospital in the United Kingdom, where an MRI of her head revealed that she was suffering a subarachnoid hemorrhage. A subarachnoid hemorrhage is a bleed into the space between the brain and the membranes surrounding the brain. Apparently, she had developed an aneurysm in an artery in her brain, which then had ruptured and started bleeding. Her description of events in the New Yorker piece matched the classic symptom of a ruptured cerebral aneurysm: the sudden onset of the worst headache of your life. Other common symptoms are nausea, vomiting, double vision, sensitivity to light, necks stiffness, seizures, disorientation, and loss of consciousness.

There are “emergencies”, like your TV or Tivo not working when Games of Thrones is being broadcast. There are bigger emergencies like having explosive diarrhea with no toilet in site. Then there are your-life-is-in-serious-danger-every minute-counts emergencies such as a subarachnoid hemorrhage. You can’t just walk off a subarachnoid hemorrhage. If you do not get treatment as soon as possible, you will die.

According to the National Institute of Neurological Disorders and Stroke (NINDS), each year ruptures of cerebral aneurysms occur in approximately 30,000 Americans. About a quarter of these unfortunate people do not even survive longer than 24 hours. Another quarter pass away within 6 months. That means ruptured cerebral aneurysms will kill at least 50% of people. Many of the surviving half will suffer long-term or permanent loss of brain function. It is possible to survive and eventually fully recover, but the likelihood depends on the size and location of the bleed and the speed at which proper treatment can be administered and the blood vessel can be repaired.

Thus, Clarke had to have emergency surgery to repair the artery. While this may sound simple, in real life there’s no CGI, no props, no stand-in brains. As I wrote previously for Forbes, when brain cells can’t get blood and thus oxygen, they die within 5 minutes. Bleeding and the resulting inflammation can cause further damage to the brain. Thus, surgeons have to act quickly to repair things as much as they can while moving delicately enough to not cause further damage. Besides stopping the bleeding and repairing the artery, other typical treatments for a ruptured cerebral aneurysm include giving anti-seizure drugs to prevent seizures and calcium channel-blocking drugs to prevent the blood vessels from having spasms that can then result in a stroke. Clarke wrote:

I remember being told that I should sign a release form for surgery. Brain surgery? I was in the middle of my very busy life—I had no time for brain surgery. But, finally, I settled down and signed. And then I was unconscious. For the next three hours, surgeons went about repairing my brain. This would not be my last surgery, and it would not be the worst. I was twenty-four years old.

This first surgery was “minimally invasive,” lasting three hours. Minimally invasive means not completely opening up the body, in this case the skull, to reach the part that needs fixing. Instead, to reach the artery in her brain, the doctors created a small hole in the femoral artery in her groin and then threaded a tube through her connected arteries up into the affected artery in her brain. They could then push a coil, a spiral-shaped object, through the tube, up to where the ruptured aneurysm was. The coil could then expand like a spring, form a clot, and consequently seal off the aneurysm.

This Cleveland Clinic video shows the different ways to repair an aneurysm:

The recovery after such an emergent procedure is the opposite of a picnic, unless that picnic involves suffering severe pain and other symptoms, having a tube constantly down your throat, and not knowing whether you will live, die, or permanently lose some type of body or mental function. During the first two weeks after such a surgery, a patient could go downhill very quickly, downhill in a bad way and not a skiing way. Therefore, a patient’s progress during this post-operative period really determines which direction he or she will eventually go.

Clarke wrote how she managed to get through these two weeks, making good progress. However, shortly thereafter, another issue emerged. When she was asked to say her name, she couldn’t remember it. Granted her full name is Emilia Isobel Euphemia Rose Clarke, which is at least two more names to remember than what most people have, and four more names than a Brazilian soccer star would have. But her inability to say her name and instead utter what she described as “nonsense”was the result of her suffering a type of aphasia. Aphasia is a general term for an impaired ability to either use or understand words that results from injury to the parts of the brain that control language.

Depending on the amount and location of the brain damage, an aphasia can be temporary or permanent. Fortunately, in Clarke’s case, the aphasia disappeared after about a week. As she described, one month after the surgery, she was able to leave the hospital and soon resume her acting career. One caveat was that the doctors had discovered a “smaller aneurysm on the other side of my brain, and it could ‘pop’ at any time. The doctors said, though, that it was small and it was possible it would remain dormant and harmless indefinitely.”

Fast forward to 2013, when she underwent a brain scan in New York City to do a routine check on her other aneurysm, the doctors, in her words, found that “The growth on the other side of my brain had doubled in size, and the doctor said we should ‘take care of it.’” Doctors first tried another minimally invasive procedure, but when things went awry and she began bleeding in her head, an emergent open surgery was necessary. The recovery from this much more invasive and involved surgery was significantly tougher, according to Clarke. But as she explained, she eventually fully recovered, except possibly that the one thing it may have “robbed me of is good taste in men.”  Her experience has inspired her to develop with others a charity called SameYou that “aims to provide treatment for people recovering from brain injuries and stroke.”

As you can see, Clarke, who is now 32 year old, had a brain aneurysm rupture and another that was at risk of rupturing while she was in her 20’s. How unusual was this for someone so young? Well, no one knows for sure what percentage of people of different ages are walking around with cerebral aneurysms. Most of the time, a cerebral aneurysm that is not leaking or has not ruptured will produce no symptoms. The exception is when the bulge begins pushing on some other structure, like a nerve to cause numbness, weakness, paralysis, or pain. If the aneurysm is near the eye or a structure that affects the eye, eye-related symptoms like a dilated pupil or changes in vision may occur. Currently, the only way to really determine how many people actually have cerebral aneurysms would be to give everyone regular brain scans, which would be ridiculously expensive. Plus, brain scans may not always detect aneurysms and could have false positives that could lead to unnecessary tests and procedures.

Cerebral aneurysms could evolve at any age but are probably more likely the older you get. That’s because an aneurysm forms when the blood vessel wall weakens and becomes thinner and more pliable, which may occur with age. High blood pressure can cause such weakening just as a garden hose may not be able to handle being connected to a fire hydrant. Certain less common infections, trauma to the head, or brain tumors can weaken blood vessel walls as well. Then, there are conditions such as connective tissue disorders, polycystic kidney disease, and arteriovenous malformations, which are abnormal connections between arteries and veins that then change how blood flows and potentially raise blood pressure in parts of the brain circulation.

What may make an existing aneurysm rupture? Anything that weakens the aneurysm walls like high blood pressure and smoking. That means anything that raises blood pressure like cocaine or other stimulant use can lead to rupture. But not all ruptures necessarily need a precipitating event. Aneurysms can just grow bigger and bigger over time until like a balloon that’s overstretched, it pops, and bad stuff ensues.

As Clarke described in her piece, she apparent kept these events quiet until now for fear of repercussions their revelation may have on her career. Such concerns are natural. Nonetheless, her revealing her medical history may now bring more needed attention to these silent time bombs. More attention could help more people get proper treatment in a more timely fashion. It could bring more attention and care to those who have suffered brain injury. It could also galvanize more research to identify better ways to detect and treat cerebral aneurysms. More awareness is especially important in this day and age when science, scientific research, and funding for scientific research are being treated a bit like many of the Game of Thrones characters in how they are being cut and eliminated.

Follow me on Twitter @bruce_y_lee and visit our Global Obesity Prevention Center (GOPC) at the Johns Hopkins Bloomberg School of Public Health. Read my other Forbes pieces here

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