Brain Aneurysms can happen in Young People too

Game of Thrones actress Emilia Clarke suffered two brain aneurysms at just 24 years old. The first was a subarachnoid haemorrhage, which led to her being rushed to the emergency room and required an endovascular coiling procedure. Recovering following a successful, minimally invasive operation, she experienced aphasia for about a week, but recovered quickly and pushed herself to return to filming on the second season of Game of Thrones.

A second aneurysm had been identified during scans following her previous collapse, and two years on a routine scan identified that it had doubled in size. She had another operation to seal off the aneurysm. This time she experienced a massive bleed and the procedure failed, requiring her to have open surgery and experience a more painful recovery.

Expert commentary from Mr Ian Sabin, Consultant Neurosurgeon, part of HCA Healthcare UK:

How common is this type of aneurysm for young people?
Generally speaking, brain aneurysms tend to affect people over age 40 therefore it is unusual for this to happen to someone so young. However, aneurysms can occur at any age. Areas of weakness in arterial walls have been found in stillborn babies but we are not born with arterial ‘berry’ aneurysms – these develop during life. There are families who have a tendency to form aneurysms, probably due to the genetic influences on the strength of arteries. Connective tissue disorders such as Marfan’s syndrome and Ehlers Danlos lead to blood vessel wall weakness and aneurysm formation. Smoking and high blood pressure have also been linked to developing brain aneurysms, along with conditions which cause high blood pressure such as polycystic kidney disease. It is estimated that at least 1% of the population has a brain aneurysm – practically the same incidence in the population as diabetes.

How do aneurysms develop?
An aneurysm is caused by a expansion in an artery from a weakness its wall, almost always at the ‘branch point’ of the artery. As blood ‘jets’ at this weakened area it can cause the artery wall to bulge out, almost like blowing up a balloon in slow motion. The brain is the most common place for an aneurysm to happen, but they can develop anywhere in the body.

What are the symptoms?
Usually aneurysms cause no symptoms until they bleed and some people can go through their whole life with a brain aneurysm without coming to any harm.

Some aneurysms can reach a very large size and are referred to as ‘giant aneurysms’. If these press on brain tissue, a variety of symptoms can occur depending on the location of the swelling. Symptoms could include:
• A dilated pupil on one side with double vision and pain behind the eye
• Progressive loss of vision
• Weakness or numbness down one side of the body
• Epileptic seizures
• ‘Stuttering strokes’ – mini strokes which can run a progressive course with increasing neurological problems

Only a small percent of the population with an aneurysm will have a rupture, and the risk is probably around 1% per year. If an aneurysm ruptures most people experience a powerful ‘thunderclap’ headache, drowsiness, violent vomiting, neck stiffness and light sensitivity. About 30% of these individuals will die at the time of the bleed but most survive and are admitted to hospital, with a mix of neurological problems. For those less affected, the temptation is to avoid seeking medical attention as it is assumed that ‘it’s just a headache’. Any violent, sudden onset headache (often described as being ‘like hit on the back of the head with a hammer’ needs urgent investigation. There are other causes such as migraine, but better to be safe than sorry and a CT head scan within 24 hours of the onset of headache will normally be diagnostic

What is the likelihood of this happening again to her?
This depends entirely on whether Emilia has any of the known risk factors – such as a connective tissue disorder or conditions causing high blood pressure. Around 15% of individuals with no obvious risk factors will have more than one aneurysm. What is unusual in her case is that the second aneurysm developed over 2 years if this is to be believed. If true, this does put her at risk of developing more and she probably should be scanned at intervals to ensure that if they develop, they are treated early

What treatments are available for brain aneurysms?
Brain aneurysms are no longer treated by neurosurgeons with open surgery as in the past. The modern treatment now is carried out by specialist radiologists who place metal coils or sleeves (stents) placed within the artery from within. Sometimes ‘coiling’ or ‘stenting’ are not possible due to the shape, size or location of the aneurysm and open surgery is then necessary. These techniques stop blood flowing into the aneurysm by sealing it off from the artery from which it has arisen.

What is the recovery time for this?
Neurovascular coiling has been shown to have a lower risk and shorter recovery time. You can usually go home 1 to 2 days after coiling surgery. With clipping surgery, it can take 4 to 6 days to recover and be discharged. The surgery or endovascular treatment is not usually the cause of a delayed discharge from hospital. If the aneurysm has ruptured, the blood around the brain can cause delayed blood circulation problems for up to 2 weeks, and most patients are deliberately kept in hospital until this risk has passed. Anyone undergoing open surgery will usually require a few months to recover, but this is very dependent on the condition of the individual before the treatment. Younger, fitter and less affected people recover quicker!

Ian Sabin

Ian Sabin is a Consultant Neurosurgeon at St Barts and the Royal London NHS Trust and at The Wellington Hospital.
Ian Sabin

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