Smoke disease was first discovered in Japan and is also known as Moyamoya disease or spontaneous basilar artery ring occlusion. It is a disease characterized by slow intimal thickening of the arteries at the ends of the internal carotid arteries and the beginning of the anterior and middle cerebral arteries bilaterally, gradual narrowing and even occlusion of the arterial lumen, and compensatory dilation and abnormal growth of the penetrating arteries at the base of the brain. The dilated blood vessels and the proliferated vascular network appear on angiogram like smoke coming out of a chimney, so the Japanese call it smog disease. The cause of smog disease is not well understood. The incidence is 42 times higher among siblings and 37 times higher in children of patients than in the general population. It is also thought to be associated with systemic infections. What are the symptoms of smog? The symptoms of smoldering disease manifest in two types — i. cerebral ischemia caused by occlusion of the internal carotid artery ii. cerebral hemorrhage induced by rupture of compensatory dilated smoldering vessels The milder ones manifest as — transient transient cerebral ischemia, headache, epilepsy, limb weakness, sensory abnormalities and changes in vision and visual field, etc. Severe manifestations – life-threatening with cerebral infarction or cerebral hemorrhage onset. Pathological changes of smoker’s disease There are three main changes as follows. (1) Occlusion or extreme stenosis of large blood vessels at the base of the brain —– The nature of the lesion of occlusive vessels is either consistent with congenital arterial dysplasia, inflammatory or atherosclerotic changes, or thrombosis, such as total arteritis in those caused by leptospirosis. (2) Anomalous vascular network: mainly located at the base of the brain and basal ganglia area. It shows thinning, dilatation and increase in the number of canal walls, easy to rupture and bleed, etc. (3) Changes in the brain parenchyma secondary to impaired blood circulation: manifests as pathological changes such as hemorrhagic or ischemic and cerebral atrophy. How to diagnose smoker’s disease? If a patient presents with unexplained above symptoms, CT and MRI images show cerebral ischemic or cerebral hemorrhagic changes. MRA or DSA should be performed, and the diagnosis can be confirmed if bilateral stenosis or occlusion of the end of the internal carotid artery with smoldering vascular formation is found. The incidence of smog 1. Smog was first discovered in Japan and occurs mainly in the yellow population, with the highest incidence in Japan, followed by South Korea and China and other Southeast Asian regions. The incidence is slightly less in males than in females, with a male to female incidence rate of 1 to 1.8. 3. There are two peaks in the age of onset, one in childhood at about 4 years of age and the other in middle age at 30-40 years of age. 4, children are more common, the ratio of children to adult incidence is 5:2. How is smog treated? There is no ideal method for the treatment of smoker’s disease at home and abroad because the cause of the disease is unknown. The EDAS indirect anastomosis method is the first choice. The extracranial vessels are led across the skull and dural barrier into the skull to promote blood supply to the cerebral cortex, and the method is effective and has few complications. With surgical treatment, the effect is satisfactory. Care for smog 1. Pay attention to rest and functional exercise of paralyzed limbs. 2.Enhance nutrition and give high protein and high vitamin diet. 3.In the presence of subarachnoid hemorrhage, the patient should not be moved, and avoid coughing, sneezing and holding the breath to defecate and other actions that increase the pressure in the chest and abdominal cavity. 4.Flooding should be prevented, rodents should be exterminated, poultry should be kept in captivity to prevent contamination of water sources, and drinking water should be disinfected. 5.Educate children not to drink raw water, not to play in infected water, bathing, etc., to avoid leptospirosis.