Unlike Emilia Clarke, it’s highly uncommon to recover from a brain aneurysm

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How to tell if it’s a headache, migraine or brain aneurysm – and what to do next
WATCH: How does one know if they’re experiencing a headache, migraine or aneurysm and how do you treat it? – Jun 8, 2017

Emilia Clarke was in the locker room of her gym, preparing for a workout, when she felt “a bad headache coming on.”

In a new essay published March 21, Clarke says she was suddenly extremely tired, but she forced herself through the first few exercises.

It wasn’t until she got into plank position that it felt as though her brain were being squeezed by an elastic band.

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“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,” writes the Thrones star. “At some level, I knew what was happening: my brain was damaged.”

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Clarke was right. She had suffered a subarachnoid hemorrhage (SAH), which she defines as “a life-threatening type of stroke, caused by bleeding into the space surrounding the brain.”

According to the the Brain Aneurysm Foundation, an estimated six million people (or 1 in 50 people) in the United States have an unruptured brain aneurysm.

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During Clarke’s SAH, there would have been bleeding in the subarachnoid space (the space inside the covering of the brain but outside of the brain itself), according to Dr. Brian Drake.

He works as a neurosurgeon at the Ottawa Hospital.

“That’s bleeding over the surface of the brain,” said Drake. “That’s where the blood vessels, which supply the brain with blood, [live.]”
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What is a brain aneurysm?

Basically, an aneurysm is a weak spot or an “out-pouching” in the blood vessel wall of an artery of the brain, akin to a blister or balloon.

“They can leak and they can rupture,” Drake told Global News. “When they rupture, they cause bleeding into the brain and over the surface of the brain, which can cause stroke and further brain injury.”

According to Drake, one-third of people who have an aneurysm rupture don’t survive. Of the remaining two-thirds who do survive, nearly half of them are left with some type of permanent disability.

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What are the symptoms?

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Usually, aneurysms don’t have any symptoms until they rupture.

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“The risk is dependent on the exact location within the brain and the size of the aneurysm,” Drake said. “Certain locations are more dangerous than others, and as they get bigger, they get more dangerous.”

Sometimes they can push on some of the nerves in your brain, which would cause pain, but Drake says this is rare. The most common way people discover an aneurysm is when a scan is needed for something else.

“[Patients often] have a headache or something else and [aneurysms are] found incidentally.”

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What causes a brain aneurysm?

Unfortunately, little is known about what causes aneurysms.

“The only really known risk factors are smoking and [high] blood pressure,” said Drake.
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They can also run in families (though they are more commonly sporadic, or not hereditary).

“For screening, the recommendation is anybody who has two first-degree family members with a known aneurysm [should be screened],” Drake said. Aneurysms are more common in people in their fifties and sixties.

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What happens when one ruptures?

“When they do rupture, the consequences are high,” said Drake.

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The most common symptoms, which occur immediately after an aneurysm ruptures, are sudden onset severe headache and stroke-like symptoms. “These include numbness or weakness in the arms and legs, difficulty with language — either understanding language or speaking — and trouble with cognitive ability.”

Clarke remembers struggling with language, a complication known as aphasia.

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“…A nurse woke me and, as part of a series of cognitive exercises, she said, ‘What’s your name?’ My full name is Emilia Isobel Euphemia Rose Clarke. But now I couldn’t remember it. Instead, nonsense words tumbled out of my mouth and I went into a blind panic,” writes Clarke.

According to Drake, Clarke is very lucky to have made a full recovery.

“For somebody to have an aneurysm rupture and survive and be free from disability, she’s already on the very good end of the spectrum,” said Drake.

How do you treat a brain aneurysm?

When someone has an unruptured aneurysm, the chances of it rupturing are low. However, if the aneurysm has already ruptured once, the chances of it re-rupturing are high.

“That risk is highest within the first 24 to 48 hours [after the first rupture], and then it decreases,” said Drake. “So the first treatment is to secure the aneurysm, and the only goal from that is not to make them any better from the rupture but to prevent it from re-rupturing.”
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Patients who survive a ruptured aneurysm are usually in hospital for two weeks, which is the amount of time necessary to ensure a vasospasm doesn’t occur. According to Cedars-Sinai, this is a narrowing of the arteries caused by a persistent contraction of the blood vessels. which can reduce blood flow.

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According to Drake, after a person has bleeding in the subarachnoid space, the body naturally breaks down that blood and reabsorbs it — similar to any other bleeding or bruising.

“The products of that process are irritating to the outside of the blood vessel walls, and it can cause… a vasospasm. For people who develop [one], they require further treatment,” said Drake.

A vasospasm can cause more stroke-like symptoms and result in more brain damage.

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