There is a little girl in the fourth grade in Beijing who is smart and beautiful and loves ballet. One day in April this year, the girl suddenly fainted on the ground while practicing ballet. The parents took the girl around for medical treatment and were finally referred to Professor Duan Lian, director of neurosurgery at the 307th Hospital of the People’s Liberation Army in Beijing, for treatment. Director Duan Lian did cerebral angiography for the girl and found that the girl had bilateral occlusion of the internal carotid arteries, resulting in a lack of blood supply to the brain, which led to fainting and was diagnosed as smog. Smog is an ischemic cerebrovascular disease Smog sounds strange. Not to mention the general public has never heard of this disease, even clinicians may not be able to recognize it clearly. In fact, smog is a form of ischemic cerebrovascular disease. In order to compensate for the decrease in cerebral blood flow, the small blood vessels at the base of the brain and the surface layer of the brain dilate and form smoke-like vessels. When the rate of compensatory vasodilation to increase cerebral blood flow is less than the rate of reduction of cerebral blood flow due to the narrowing of cerebral blood supply arteries, cerebral ischemic symptoms arise, such as cerebral infarction, cerebral atrophy, and cerebral softening. Because the dilated blood vessels look like curling smoke coming out of a chimney during angiography, they are imaginatively called smoky disease. Smoky disease is a local reflection of systemic vascular lesions, and the main lesion is intimal elastic fiber hyperplasia of the internal carotid artery, which gradually breaks the lumen of the internal carotid artery and eventually occlusion occurs. Smoldering lesions mostly occur at the end of the internal carotid artery, the beginning of the anterior and middle cerebral segments, and occasionally spread to the main trunk of the anterior and middle cerebral arteries, as well as the external arteries of the moving carotid, and even the vessels of other parts of the body. The symptoms of smoker’s disease are complex, mainly manifesting as headache, epilepsy, sudden limb numbness and weakness, abnormal sensation, loss of reading, aphasia, blurred vision, hemiplegia, hemianopia, and mental retardation. The seizures usually resolve on their own after a few minutes to a few hours, and the above symptoms can be repeated, alternating and slowly aggravated. The clinical manifestations of smoker’s disease vary depending on the severity of cerebral ischemia. In mild cases, the main manifestations are headache, epilepsy, limb weakness and vision changes, while in severe cases, the disease starts with cerebral infarction or cerebral hemorrhage and becomes life-threatening. There is a certain genetic predisposition. There are two main types of smoker’s disease onset, one is cerebral ischemia caused by occlusion of the end of the internal carotid artery, and the other is cerebral hemorrhage caused by the rupture of compensatory dilated cerebral vessels after cerebral ischemia. There are two peaks in the age of onset, one in childhood around the age of 4 years and the other in middle age between 30 and 40 years. The main symptom in children is cerebral ischemia, which occurs after crying or fatigue with transient limb numbness and paralysis, sometimes with alternating numbness and paralysis in both limbs. Adults in their 30s, on the other hand, tend to start with acute intracranial hemorrhage, manifesting as cerebral infarction or cerebral hemorrhage. Smoky disease has a certain genetic predisposition. Foreign studies have shown that the incidence among siblings is 42 times higher than in the general population, and the incidence in children of smog patients is 37 times higher than in normal people. 307 Hospital neurosurgery department had admitted a mother and son with smog disease that might be related to congenital genetic defects, and the patient was from Fangshan, Beijing. After crying for a while, the 5-year-old boy suddenly developed paralysis of one limb and was unable to move, and was diagnosed with smog. When the boy’s mother was also asked about her past medical history, she was told that she had had a brain hemorrhage, and an MRI confirmed that she also had smog. The diagnosis should be followed by prompt surgery. Smog is quite difficult to treat. In the past, due to the limitation of examination and treatment, there was a lack of proper understanding of smog disease, and the diagnosis was unclear, and it was sometimes treated as epilepsy, arteritis or Grimballi syndrome, which delayed the disease. Internal medicine treats the disease symptomatically with vasodilators as well as antibacterial drugs, but the effect is not obvious. Surgery usually used buccal muscle patching, intracranial graft patching of the greater omentum and direct anastomosis of extracranial vessels in the past, which was effective but still not ideal. Nowadays, with the development of imaging technology, the diagnosis of smoker’s disease is not a problem, and the correct diagnosis can be obtained by MRI. After the diagnosis of smog disease is confirmed, the main treatment is surgery, in which the extracranial blood vessels are led across the skull and dural barrier to the intracranial area to promote the blood supply to the cerebral cortex, thus improving the blood circulation of the patient’s brain tissue and significantly relieving the ischemic symptoms. Because of bilateral intracranial ischemia, two surgeries are usually necessary, and the first surgery can be discharged within 10 days. After 3 months of rest, another surgery is done to complete the whole treatment. The cost of surgical treatment is about 50,000 yuan. For patients with smog, early detection and diagnosis and treatment is the key. First of all, PET and functional MRI should be done for scientific and correct diagnosis and timely surgery after the diagnosis is confirmed. Most of the patients who have early surgery can fully recover their normal life. If treatment is delayed, once brain hemorrhage or cerebral infarction occurs, it may lead to hemiplegia, disability, or even life-threatening. Smoker’s disease was first discovered by the Japanese and was once considered a difficult disease unique to Japan. As early as 1960, Japanese scholars had already noticed the emergence of smog, and the first case of smog was officially reported in 1961. In 1969, Japanese scholars Suzuki and Takahisa published their first paper under the name of MOYAMOYA, and smog was officially recognized from then on. The highest incidence of smog is in Southeast Asia, including Japan, Korea, and China, with a prevalence of 1:1.6 times for men and women, with men slightly higher than women. It is best for women with smog to become pregnant after treatment, and a safety plan for delivery should be developed jointly by obstetricians, neurosurgeons, and anesthesiologists. Patients with smog should avoid working at heights, driving cars, swimming and other sports before treatment to avoid danger.