The final season of Game of Thrones premiered this past Sunday, but the show’s biggest revelation occurred weeks before. That’s when its star, Emilia Clarke, published a personal history in The New Yorker that contained a secret: As the first season’s filming wrapped, Ms. Clarke had suffered two brain aneurysms. Her struggle to understand what happened and how to best recover from her brain injury made for a heartbreaking and inspiring read. It also set off a frenzy online, as the number of searches for “Emilia Clarke and brain aneurysm” quickly grew into the millions.
We thought it would be a great time to turn to our own expert, Speech-Language Pathologist Emily Dubas, MS, CCC-SLP, for more insights into this little-known condition. We asked Emily the essential questions about brain aneurysms, brain rehabilitation, and how Ms. Clarke’s experience compares to that of her own patients.
First, what exactly is a brain aneurysm?
It is a weakening in the wall of an artery that causes a bulging of the wall, and it can happen anywhere in the body. An unruptured aneurysm does not typically present with symptoms, so many people have aneurysms and don’t know it. But aneurysms that cause a rupture can lead to more severe complications, or death. When a brain aneurysm ruptures, blood can leak into the brain and cause a hemorrhagic stroke. That is what has happened to some of the patients I’ve worked with, and that’s what Emilia Clarke described happened to her.
Are there warning signs?
A lot of my patients describe going about their daily life and then getting a sudden, terrible headache. That is a very common sign of a ruptured brain aneurysm.
Do we know what causes a brain aneurysm, or who typically has them?
We don’t know the causes, but there are risk factors. A strong family history of aneurysms can contribute, but so can things that are more in our control, such as drinking excessive amounts of alcohol, recreational drug use, smoking, and high blood pressure. Women and adults over the age of 40 are more likely to have an aneurysm, but aneurysms can happen at any age, to anyone. I have treated a number of people who are in their 20s, the same age Emilia Clarke was when she had her incident.
What is the typical treatment path? And what does brain rehabilitation look like?
Blood leaking into the brain can cause damage to the cells it touches and the surrounding cells, and it increases pressure in the brain. A hemorrhagic stroke can also lead to other complications like an ischemic stroke, because some of the blood vessels may get constricted. The first thing doctors do is run diagnostic tests such as a brain scan. They may need to perform surgery. Two common treatments for an aneurysm are surgical clipping and endovascular coiling. If an aneurysm ruptures, some individuals may receive rehabilitation services. A treatment plan to rebuild affected skills would be developed by the rehab team, which may consist of a speech-language pathologist, a physical therapist, and/or an occupational therapist. That rehabilitation plan is personalized based on where the aneurysm occurred and how severe it was, as well as which speech, language, cognitive, and physical skills have been affected.
Can people hope for a full recovery?
Emilia Clarke was able to get back her communication abilities and return to work on the Game of Thrones set. But everyone’s recovery is different. Some people recover quickly, and others don’t, and we don’t have firm answers as to why or when. Emilia Clarke shared that her recovery experience had both ups and downs, which is something many people can relate to after a brain injury. Through the ups and downs, it’s important to keep hope, motivation, and set goals for yourself. Rehab is a key part of many people’s recovery. Your rehab team will work on affected skills and help you build home therapy programs so you can continue to work on these skills between sessions and after discharge. In addition to rehab, creating small, measurable goals to work towards, finding meaningful activities to do every day, and building a support network can help.
We’re hearing more about strokes and aneurysms of late. Are they becoming more prevalent?
Social media is helping us all become more aware of health issues. There are also incredibly courageous people like Emilia Clarke or the family of Luke Perry who openly share their stories so that others can learn from their experiences. This openness helps remove the stigma that people face, especially for those who want to return to work. I think in the past there was a “just try harder, you’ll be fine,” type of mentality, and after a brain injury, many people would assume that because you look fine, you are fine. But the general public is becoming more aware of what types of injuries can happen to the brain and how it can affect thinking, communication, or physical abilities, and this increased awareness is a good thing.
What advice do you have for those who are hesitant about sharing their own experience, especially with their employer?
Everyone’s situation is different, and there’s not one right answer about sharing their experience. It is ultimately up to the individual to decide who they want to share this with and how much they want to share about their injury and plan for brain rehabilitation. I hope that Emilia Clarke’s story helped people know they’re not alone. You can get back to what means the most to you, or find a way to adjust to a new normal where you still have meaningful things in your life. There are many paths forward, even if your path starts in a completely different place than a Hollywood star.
Since her injury, Emila Clarke has started an organization called Same You to create more awareness around brain aneurysms and to advocate for more access to brain rehabilitation. Knowing that many viewers admire her strong woman-warrior character, Daenerys Targaryen, she felt she might able to influence the way people think about brain injury. Perhaps her determination to not only fight back but to thrive, can be summed up by her character’s memorable line in Season 5 – “I’m not going to stop the wheel. I’m going to break the wheel.”