Why Emilia Clarke's recovery from 2 brain aneurysms is so remarkable: I'm in the really small minority

Why Emilia Clarke's recovery from 2 brain aneurysms is so remarkable: I'm in the really small minority

There are parts of British actress Emilia Clarke's brain that are "missing" from scans, she recently told BBC OneSunday morning. The damage is the result of two brain aneurysms Clarke suffered while workinggame of Thrones2011 and 2013.

“The amount of my brain that is no longer usable is remarkable, that I am able to speak articulately at times and live my life normally without repercussions,” said Clarke, 35Sunday morningSophie Raworth. “I’m in the really, really, really small minority of people who can survive this.”

Clarke's full recovery may be even rarer than the brain aneurysms themselves. Here's what we know about brain aneurysms - and why Clarke's recovery is so "remarkable."

What is a brain aneurysm?

What Clarke suffered first in 2011 and again in 2013 was a subarachnoid hemorrhage (SAH), which refers to bleeding between the skull and the brain. A SAH is a type of hemorrhagic stroke, and Clarke's hemorrhage was caused by ruptured cerebral aneurysms.

"When you have a weakening of the blood vessel wall, that weakening slowly turns into a little balloon. And that little balloon is called an aneurysm," said Risheng Xu, MD, PhD, assistant professor of neurosurgery at Johns Hopkins University School of MedicineThe health."And the reason that's risky is because if that aneurysm ruptures, it causes a [SAH]."

These aneurysms are associated with a number of different causes, although it can sometimes be unclear which factors are responsible. High blood pressure, smoking, heavy drinking, illegal drug use, genetic risk factors from your family history or ethnic background, or sometimes just chance, can all play a role in whether a person develops an aneurysm, explained Dr. Jennifer Frontera, Professor of Neurology in the Department of Neurocritical Care at NYU Langone.

People assigned female at birth (AFAB) and people between the ages of 40 and 60 are more likely to have these aneurysms rupture, she added, although it is unclear why. Clarke's first break - which happened when she was in her mid-20s - is certainly unusual.

Sometimes when young people have aneurysm ruptures, it's because someone else in their family has had one, too, explained Dr. Frontera, although Clarke hasn't commented on whether that's the case for her.

"In general, there are about 30,000 people in the U.S. with subarachnoid hemorrhage each year. So, broadly speaking, it would be considered a rare condition," said Dr. FronteraThe health.

How to recognize strokes and stroke-like symptoms - even in young people

Brain aneurysm signs and symptoms

As Clarke's severe symptoms might suggest, ruptured brain aneurysms can be debilitating for those who get them.

"I immediately felt like a rubber band was squeezing my brain. I tried to ignore the pain and push through it, but I just couldn't," Clarke wrote in a personal story forThe New Yorkerin March 2019.

This severe headache that comes out of nowhere is typical of the rupture of a brain aneurysm.

"Most aneurysms are actually completely asymptomatic until they rupture, and when they rupture they cause a [SAH], people classically experience what is called the worst headache of life. And it's a sudden onset. It's not a gradual process," Dr. Xu. “Patients have described it as being hit in the head with a bat.”

According to the National Institute of Neurological Disorders and Stroke (NINDS), a ruptured aneurysm can also cause:

Double vision, nausea and vomiting, stiff neck, sensitivity to light, cramps, unconsciousness, cardiac arrest

Seeking medical attention as quickly as possible is the only way for patients to survive bleeding as severe as SAH. Unfortunately, Dr. Frontera, she suspects that only about half of people who suffer from a brain aneurysm make it to the hospital. According to NINDS, 25% of people who suffer from a ruptured aneurysm do not survive the first 24 hours; another 25% die within six months.

For people who survive a ruptured aneurysm, the success of full recovery depends on a number of factors.

“Patients who arrive in relatively good condition – still able to interact and communicate, etc. – have, as you can imagine, better long-term outcomes,” said Dr. Frontera. “For the sickest patients who are in a coma, their chances of fully returning to normal are much lower.”

Recovery Process: A Steep Path to Climb

For patients who survive a ruptured aneurysm and SAH, the treatment and recovery process is not an easy task. According to NINDS, some people who suffer from subarachnoid hemorrhage may have permanent neurological damage; others can recover with little to no disability.

In any case, rapid diagnosis and treatment is required, and once patients with this type of cerebral hemorrhage are admitted to the hospital, doctors must act quickly to stop the bleeding. This can be done in a number of ways, explained Dr. Xu. In some cases, a traditional craniotomy (brain surgery) may be performed, which involves closing the blood vessel; Newer procedures can stop bleeding by inserting coils or stents into the blood vessel.

It's also important for doctors to look for other problems in the brain after a rupture. Sometimes the bleeding can irritate other blood vessels in the brain, causing other areas to spasm and causing more strokes, Dr. Frontera.

Despite the complexity of the process, technological and medical advances mean patient outcomes continue to improve.

“We've had a lot of advances in both neurocritical care and neurosurgery that have really improved outcomes for patients over the last few decades [SAH] and we continue to make progress,” said Dr. Frontera. “Even patients who are more severely affected still have a reasonable chance of functional independence and meaningful recovery.”

And although Clarke defied the odds and is back to normal after her SAH, as she told BBC One'sSunday morningShe still lost some of her brain function during the ordeal.

"As soon as any part of your brain doesn't get blood for a second, it's gone," Clarke explained. “And so the blood finds a faster, different way to move, but then everything it lacks is gone.”

Clarke's explanation for the "missing" parts of her brain is quite apt. "When parts of the brain are injured, it essentially dies and is somehow reabsorbed over time," Dr. Xu. “So on a scan you can actually see areas where brain injuries have occurred.”

Although many patients with this type of injury must learn to do many of the things that once came naturally to them, Clarke's youth may also have helped her return to normal. The “plasticity” of their young brains, explained Dr. Frontera, may have made it easier for Clarke's brain to work around the injury and adapt various functions in new ways.

"Most patients are in the hospital for at least two weeks, if not longer. And many patients need to be weaned off the ventilator, they basically need to go through intensive rehab to really be able to function again, to be able to walk, to do their everyday activities," Xu said. "It's a huge recovery process. And for someone like [Clarke] to go through so much is remarkable."