Emilia Clarke revealed earlier this week that while the world was falling at the feet of the ultimate feminist queen she embodies on Game of Thrones, she suffered not one but two brain aneurysms that nearly killed her.
Aneurysms—which are one and a half times more common in women—are about as scary a diagnosis as you can get. They sound innocuous enough: blood-filled sacs that form on the side of a blood vessel, almost like a berry hanging off a vine. But they’re ticking time bombs.
Aneurysms hide in the brain rarely giving off any warnings that they’re there until it’s too late. If an aneurysm ruptures (which is also one and a half times more likely to happen in women), it can be catastrophic. “For a patient who has a rupture like Clarke did, the reality is that 40 percent of those patients don’t survive,” says Jeremy Heit, M.D., Ph.D., assistant professor of radiology and neurosurgery at Stanford University. “Of the people that survive, a third of them will do great like Clarke and make a full recovery, but the other two thirds will be left with some degree of disability.”
In an essay for The New Yorker, Clarke shared that after she’d finished filming season one of GoT, she was in the middle of a workout when suddenly it felt as though her brain was being squeezed inside her skull. “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,” she wrote. She dragged herself to the bathroom “and proceeded to be violently, voluminously ill. Meanwhile, the pain—shooting, stabbing, constricting pain—was getting worse,” she continued. “At some level, I knew what was happening: My brain was damaged.”
An aneurysm rupture is often described as the “worst headache of my life”—the phrase is so consistent that doctors are taught to immediately investigate a possible aneurysm when they hear it. “The way patients describe it to me, it’s like a light switch," Dr. Heit says. "It’s instantaneous, like someone flicked a switch and they just have this horrendous headache.” It’s an entirely different category of pain, he says, worse than any normal headache or even migraine. It’s so remarkable, “the vast majority of people know that there’s a problem,” he says. “If it’s something that’s really quite different or it really is the worst headache of your life, don’t mess around with that. You need to get to a hospital and get evaluated.” Other key signs to look for: vomiting, dizziness, loss of consciousness, and stiffness in your neck. Some patients even have seizures.
At the hospital Clarke was diagnosed with a subarachnoid hemorrhage (SAH), a type of stroke and the neurological term for a ruptured aneurysm.
Doctors aren’t completely sure what causes aneurysms—lifestyle factors like hypertension, smoking, and drug use have all been linked to aneurysms, and genetics might also play a role—or why they happen in women as young as Clarke, who was only 24 at the time. (Aneurysms typically happen in women over 35.)
Doctors do know that a nightmare gym scenario like Clarke’s isn’t an uncommon way for an aneurysm to pop. Increased blood pressure from a strenuous activity like working out—or even orgasm—can cause that quietly ticking time bomb to explode. Emotional stress even has the potential to cause an aneurysm to rupture, says Gary Steinberg, M.D., Ph.D., chief of neurosurgery at Stanford Healthcare and chair of the department of neurosurgery at Stanford University.
“Once an aneurysm has bled once, it’s kind of a bad actor," says Dr. Heit. "The risk of it bleeding again is relatively high.” That typically means immediate surgery to seal off the aneurysm. Option one is full-on brain surgery. “A surgeon will make an incision through the skin," he explains, "take part of the skull off, find the aneurysm, and then put a little clip—it’s kind of like the clip you put on a bag of potato chips to keep them from going stale—right across the point where the aneurysm is attached to the blood vessel.” It’s a great solution, but it’s also brain surgery. The recovery process can take months.
Option two is almost unbelievably high-tech. A surgeon will insert a tiny catheter—basically a hollow plastic tube—into an artery in the leg, manually threading it through the highway of blood vessels in the body with incredible precision until the tube makes it into the brain and into the aneurysm itself. “Imagine you’ve got a really tiny plastic tube and the tip of it is in the aneurysm in the brain and the other end of it is in your hand coming out of the patient’s leg,” Dr. Heit says. Once the surgeon is inside the aneurysm, he or she threads teeny-tiny platinum coils—about the size of a strand of hair—into the aneurysm, plugging it from the inside. “Our patients leave our procedure room with just a band-aid on their hip,” Dr. Heit says.
The cognitive recovery after a brain bleed, however, can be much more difficult. Clarke suffered from aphasia, a result of brain trauma that can make it difficult to process language. “My full name is Emilia Isobel Euphemia Rose Clarke. But now I couldn’t remember it,” Clarke wrote. “Instead, nonsense words tumbled out of my mouth and I went into a blind panic. I’d never experienced fear like that—a sense of doom closing in. I could see my life ahead, and it wasn’t worth living. I am an actor; I need to remember my lines. Now I couldn’t recall my name.”
Clarke spent a month in the hospital, eventually regaining her control of language—just weeks before she had to be on set to start filming season two of GoT. But there was one other problem: While she was in the hospital, doctors had found a second aneurysm in Clarke’s brain, which happens in about 20 to 35 percent of aneurysm patients, says Dr. Steinberg.
The majority of aneurysms don’t rupture—an estimated 6 million people in the U.S., or one in 50 people, have one and might not even know it—so her doctors elected just to keep a close eye on it while Clarke got back to her life of taming dragons. “On the set, I didn’t miss a beat, but I struggled,” she says. “If I am truly being honest, every minute of every day I thought I was going to die.” But after she wrapped filming season three, a brain scan revealed her aneurysm had doubled in size. During the procedure to plug it, her second aneurysm ruptured, flooding the surface of her brain with blood.
After a rupture, your body works to clear away that blood, but it can be an excruciating and dangerous process, potentially triggering a different type of stroke. “That’s a whole second process that patients have to survive,” Dr. Heit says. Anecdotally, he says he sees this happen more often in young women like Clarke, who spent another month in the hospital recovering. “At certain points, I lost all hope,” she wrote. “There was terrible anxiety, panic attacks.... I felt like a shell of myself.”
Clarke is one of the lucky ones. “She beat the odds,” says Rahul Jandial, M.D., Ph.D., author of Neurofitness and a brain surgeon and neuroscientist at City of Hope hospital in Los Angeles. “When an aneurysm pops, it’s often deadly. It has to be fixed with surgery, and you have to survive the major medical issues that arise with a long stay in the ICU.”
So what do women need to know? “Aneurysms don’t cause migraines,” Dr. Jandial says. If you get a headache, or even a migraine, in the middle of your next run, it doesn’t mean you’re having an aneurysm. Doctors stress these headaches are unlike anything you’ve ever experienced; you’ll know something isn’t right. But it’s vital to listen to your body—don’t try to muscle through the pain or wait to see if it passes. “If you’re ever in doubt, just see a physician,” Dr. Heit says. “Always err on the side of making sure you catch something potentially dangerous before it’s a bigger problem.”