Why Emilia Clarke's Recovery After 2 Brain Aneurysms Is So 'Remarkable': 'I Am in the Really Small Minority'

There are sections of British actor Emilia Clarke's brain that, on scans, appear to be "missing," she recently told BBC One's Sunday Morning. The damage is a result of two brain aneurysms that Clarke suffered while working on Game of Thrones in 2011 and 2013.

"The amount of my brain that is no longer usable, it's remarkable that I'm able to speak, sometimes articulately, and live my life completely normally without repercussions," Clarke, 35, told Sunday Morning's Sophie Raworth. "I am in the really, really, really small minority of people that can survive that."

Clarke's full recovery may be even more rare 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 for the first time in 2011, and then again in 2013, was a subarachnoid hemorrhage (SAH), which refers to bleeding in the space between the skull and the brain. An SAH is a type of hemorrhagic stroke, and Clarke's bleeding was caused by cerebral aneurysms (brain aneurysms) that burst.

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

These aneurysms are linked to a number of different causes, though it can sometimes be unclear which factors are to blame. High blood pressure, smoking, heavy alcohol use, illicit drug use, genetic risk factors from your family history or ethnic background, or sometimes, just pure chance can all play a role in whether a person will develop an aneurysm, explained Jennifer Frontera, MD, a professor of neurology in the division of neurocritical care at NYU Langone.

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

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

"Generally speaking in the US each year, there's about 30,000 people that have subarachnoid hemorrhages. So in the grand scheme of things, it would be considered a rare disorder," Dr. Frontera told Health.

Brain Aneurysm Signs and Symptoms

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

"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," Clarke wrote in a personal story for The New Yorker in March 2019.

This severe and out-of-nowhere head pain is typical when a brain aneurysm bursts.

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

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
• Seizures
• Loss of consciousness
• Cardiac arrest

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

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

"Patients that arrive in relatively good condition—still able to interact and communicate, etc.—have, as you might imagine, better long term outcomes," Dr. Frontera said. "The sickest patients who are comatose, their chances of returning completely back to normal are again much lower."

Recovery Process: A Steep Road to Climb

For patients who survive a ruptured aneurysm and SAH, the treatment and recovery process is no easy task. According to the NINDS, some people who suffer a subarachnoid hemorrhage may have permanent neurological damage; others can recover with little to no disability at all.

In any case, swift diagnosis and treatment is necessary, and once patients with this kind of brain bleeding are admitted to the hospital, doctors have to work fast to stop the bleeding. This can be done in a couple of different ways, Dr. Xu explained. In some cases, a traditional craniotomy (brain surgery) may be done, during which the blood vessel is clamped shut; newer procedures may stop the bleeding by inserting coils or stents into the blood vessel.

It's also important for doctors to keep an eye out for other issues in the brain after a rupture. Sometimes the bleeding can irritate other blood vessels in the brain, causing other areas to spasm and cause more strokes, Dr. Frontera explained.

Despite how complicated the process is, technology and medical advancements mean that patients' results are getting better.

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

And though Clarke defied the odds and is back to normal after her SAH, as she told BBC One's Sunday Morning, she still lost part of her brain function in 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 quicker, a different route to get around but then whatever bit it's missing is therefore gone."

Clarke's explanation for the "missing" parts of her brain is pretty spot-on. "When parts of the brain are injured, it essentially sort of dies off and over time kind of gets reabsorbed," Dr. Xu said. "So on a scan, you can actually see areas where there has been brain injury."

Though many patients with this kind of injury have to learn how to do many of the things that used to come second nature to them, Clarke's youth may have also helped her bounce back to normal. The "plasticity" of her young brain, Dr. Frontera explained, may have made it easier for Clarke's brain to work around the injury and adapt different functions in new ways.

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