UCI Health neurosurgeon discusses “Game of Thrones” star Emilia Clarke’s brain aneurysms

March 22, 2019

“Game of Thrones” star Emilia Clarke revealed this week that she had two life-threatening brain aneurysms, including one that ruptured after wrapping the first season of the hit show when she was just 24.

UCI Health neurosurgeon Li-Mei Lin, MD, says 30,000 Americans each year suffer from a burst aneurysm in the brain. About six million more have an aneurysm that hasn’t yet ruptured. An aneurysm is a weakened arterial wall that forms a bulge which can then break and bleed into the brain, causing a life-threatening hemorrhage.

The British actress, who plays fan favorite Daenerys Targaryen on the hit HBO series, revealed in the New Yorker that she was rushed to a London emergency room after collapsing during a gym workout in early 2011.

A brain scan quickly determined that Clarke had suffered a subarachnoid hemorrhage (SAH), a type of stroke caused by a ruptured aneurysm. Doctors treated her aneurysm, but warned her about a smaller bulge that could burst at any time. Her medical team decided to monitor the smaller one for potential complications.

Lin, who specializes in minimally invasive endovascular treatments of aneurysms, says many doctors tell patients that small aneurysms can be safely monitored, advice she considers unwise. “We have so many tools available today. We can repair even small aneurysms and prevent potentially deadly results.”

Clarke eventually did have surgery after season three to repair the smaller bulge.

Lin, assistant professor of neurological surgery at UCI School of Medicine, is Orange County’s leading brain aneurysm expert, having trained in both vascular and neurointerventional neurosurgery. She discusses the myths and facts surrounding aneurysms.

MYTH: Small aneurysms are safe, and won’t rupture.
All aneurysms have the potential to rupture. A brain aneurysm forms from a weakened area of an artery in the brain, resulting in an abnormal bulge that can burst and cause a life-threatening hemorrhage. The average size of a ruptured aneurysm is 4.5 millimeters. If patients become aware of an aneurysm in the brain, they are often told by primary care providers and neurologists that they can be safely monitored and do not need treatment. This is false. Small aneurysms can be safely and successfully treated, preventing the potentially fatal effects from a rupture.

MYTH: All neurosurgeons and neurointerventionalists can treat aneurysms.
Any patient diagnosed with an aneurysm should be evaluated by an aneurysm specialist who is experienced in all treatment modalities. For the same reason you wouldn’t put a first baseman on the pitcher’s mound, patients and providers should not expect a neurosurgeon or a neurointerventionalist without specialized training to be able to offer the full range of treatment options for an aneurysm.

Q: Are aneurysms common among young women?
It is uncommon for women to have an aneurysm at her age. More commonly we see them in people ages 40 to 60. But it is overwhelmingly more common in women than in men. In clinical trials on brain aneurysm treatments, at least 80 percent to 90 percent of patients are women.

Q: Clarke’s first aneurysm burst while working out. Could this have been a factor?
During workouts, we likely have temporary increase in blood pressure from the strenuous activity. High blood pressure is a known risk for aneurysm rupture as well as for aneurysm growth.

Q: What are the symptoms to look for?
The most telling sign is if a patient is having the worst headache of his or her life. Most people, including primary care doctors and other doctors who are not familiar with brain aneurysms, don't know this. Other symptoms of brain aneurysm can include difficulty with eye movements, double vision, even seizures.

Q: What is involved when a brain aneurysm is “clipped”?
Surgical clipping occurs when a small metal clip is placed at the neck of the aneurysm to stop blood flow. This approach is performed by a neurosurgeon.

Q: Is coiling an effective treatment for an aneurysm?
Coiling is a minimally invasive endovascular treatment where metal coils fill inside the aneurysm, causing a clot to form in the aneurysm. Aneurysms recur in as many as 20 percent of cases.

Q: Are there newer techniques available?
For decades, clipping and coiling were the only options for treatment. The newest technique for the endovascular treatment of brain aneurysms is flow diversion. This approach involves placement of a flow diverter stent to block blood flow into the aneurysm. Over time a blood clot forms in the aneurysm and the flow diverter stent also provides a scaffold for new blood vessel cells to grow, sealing off the aneurysm from the main artery, essentially curing the aneurysm. This approach avoids having to go into the aneurysm — a distinct advantage for small aneurysms, which have a high risk of rupture during the coiling treatment. 

About Lin: Li-Mei Lin, MD, is a national expert on minimally invasive brain aneurysm treatments. She is currently the only specialist in Orange County to offer the newest endovascular treatments for this condition.

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