1, recently the doctor said I have smog disease, but the name even sounds a bit funny, is my brain “smoke”?
Smoke disease is a kind of cerebrovascular disease, also known as spontaneous basilar artery ring occlusion, is a disease characterized by the end of the internal carotid artery and the front of the brain, the beginning of the middle cerebral artery arterial intima thickening slowly, the arterial lumen gradually narrowed to occlusion, the base of the brain through the artery compensatory expansion, the expansion of the blood vessels in the form of angiography, such as the chimney out of the curl of smoke. In layman’s terms, this is because the main blood vessels of the brain are blocked, the brain ischemia and cause a series of symptoms, this disease is called smog disease.
2, how this disease has not heard of before, is a very special strange disease?
Smoke disease, like cerebral infarction, cerebral hemorrhage, belong to a kind of cerebrovascular disease, is not a strange disease. Smoke disease is a disease that only began to be recognized in the 1960s, the general public in China lack of understanding of this disease. Even many primary care doctors do not know about smog, so most of the smog patients are not diagnosed, let alone treated. In fact, our survey found that the incidence of smog is not low in China. It is mostly found in children and young and middle-aged people under 40 years old.
3.What causes smog?
The cause of smog is still not well understood. It is 42 times more common in siblings and 37 times more common in children of patients than in the general population, and recently it has been found that the occurrence of smog is related to genetic abnormalities of chromosomes. Therefore, some scholars believe that the occurrence of smog may have a genetic relationship. In the past, head and neck infections were thought to be the cause of smog, but statistical analysis of large numbers of cases showed no correlation between the occurrence of smog and these local infections. In conclusion the etiology of smog is not well understood. It may be related to genetics, but it may also be related to infection, autoimmune status, and growth environment.
4. Is this disease hereditary? Who is susceptible to the disease?
According to our findings, smog has a tendency to occur in families, and many families with smog have been found. Therefore, it is important for the family members of smog patients to be examined to rule out asymptomatic smog. Some areas have a high prevalence of smog, such as Shandong, Hebei, and some areas of Heilongjiang. In particular, there are many patients concentrated in certain villages. This may be related to the environment.
Unexplained headache, limb weakness, numbness, aphasia, cerebral infarction or cerebral hemorrhage should be considered smog.
5. What are the symptoms I should suspect if I have smog? What are the symptoms of smog?
The symptoms of smog disease can be broadly classified into two types: cerebral ischemia caused by occlusion of the internal carotid artery and cerebral hemorrhage induced by rupture of compensatory dilated smoke-like vessels. The disease is divided into 6 types according to the severity of the disease. In mild cases, the symptoms are transient transient cerebral ischemia, headache, epilepsy, limb weakness, sensory abnormalities and visual field changes, while in severe cases, the disease starts with cerebral infarction or cerebral hemorrhage and becomes life-threatening.
In general, children or adults with unexplained headache, limb weakness, numbness and aphasia should consider whether it is a smoker’s disease and need to go to the hospital for further examination.
It is especially important to note that some children have low intelligence and slow development, also due to brain ischemia and poorly developed brain tissue caused by smog. There are also some patients with mental abnormalities and psychiatric disorders that have been found to be caused by smog.
If smog is not treated in a timely manner, cerebral infarction can occur in severe cases, which is known as stroke in Chinese medicine. After a cerebral infarction, there will be hemiplegia, inability to speak clearly or to speak, and some people may have reduced vision, difficulty seeing, or visual field defects. There are other less common symptoms, such as inability to extend the tongue and difficulty swallowing. In severe cases, disorders of consciousness may occur.
There are also a few patients who start with cerebral hemorrhage. Patients with hemorrhagic type, who usually act like normal people with no or few discomfort symptoms, have sudden onset of severe headache followed by nausea and vomiting, and soon become comatose. Upon arrival at the hospital, it is a cerebral hemorrhage, and then further examination is due to brain hemorrhage caused by smog. This part of the patient’s condition are very serious, serious has been in a coma state, or even if awake also have serious functional impairment.
6.I heard that eating noodles can also cause smog?
Many parents of children with smoker’s disease say, “My child got sick after eating noodles, what is the reason? The reason is very simple, because there is a sucking action when we eat noodles, and this action will cause an increase in gas exchange, called hyperventilation. This is because after hyperventilation can cause cerebral vasospasm and cerebral ischemia. In normal people, the compensatory capacity of the cerebral blood vessels is good, even if the blood vessels are slightly spasmed, it can be corrected quickly, and the brain tissue is more tolerant to the lack of oxygen. This is not the case for smoky patients. Even a little bit of ischemia and vascular spasm can cause limb weakness, aphasia, limb numbness, and other symptoms.
Many children also have limb weakness and numbness when playing games, or after a temper tantrum or crying, also because the excitability of brain tissue increases after crying and oxygen consumption increases, but the blood vessels cannot increase the intracranial blood supply because of hyperventilation spasm, so the performance of cerebral ischemia, limb weakness, speech impairment, limb numbness, etc. is produced.
7. Since smog is a blockage of cerebral blood vessels causing cerebral ischemia, why are some patients with cerebral hemorrhage also smog?
There are many causes of cerebral hemorrhage, the common ones are hypertensive cerebral hemorrhage, subarachnoid hemorrhage, ruptured aneurysm hemorrhage and so on. Smoke disease brain hemorrhage is also one of the causes. Because of intracranial vascular malformations in smog patients, the blood vessels themselves are structurally unhealthy and can develop poor vascular elasticity, increased brittleness, and even the formation of tiny aneurysms. These unhealthy blood vessels often then rupture and bleed. After bleeding, the patient will exhibit severe headache, nausea, vomiting, and neck pain. In severe cases, they may become unconscious. Patients with brain hemorrhage from smog are mostly young adults in their 30s and 40s. Therefore, for unexplained cerebral hemorrhage in young adults, it is important to think whether it is caused by smog.
8.How to diagnose smog?
In terms of clinical symptoms, if children or adults have unexplained headache, weakness, numbness, aphasia, or brain hemorrhage, they should consider smog. There are many diagnostic tools available, and CT and MRI images can show ischemic or hemorrhagic changes in the brain. Further MRA or DSA examinations can confirm the diagnosis if there is bilateral stenosis or occlusion of the internal carotid arteries with smoky vascular formation. If smog is suspected, cerebral angiography, which is also the gold standard for the diagnosis of smog, is advisable. For evaluation of the patient’s condition, a series of further tests such as brain Doppler ultrasound and PET are required.
It is important to emphasize that smog must be a bilateral lesion with an unknown etiology. Therefore, unilateral cerebrovascular disease or disease due to leukoaraiosis, arteritis, encephalitis, lupus erythematosus, and other clear causes cannot be diagnosed as smog.
Many of the patients I see present with symptoms such as hemiplegia and numbness of the limbs without being able to find out the cause. All that is needed is an additional angiogram during the MRI to make a clear diagnosis. However, it is sad to see that many patients have not been diagnosed in time and delayed treatment because of such a small number of tests. This leads to serious disabilities and serious consequences for the family and the person.
9.I have been to many hospitals and they all say that there is no cure for smog, is that so?
Many doctors in China used to think that smog is untreatable. Many patients were diagnosed with smog, and the doctors’ helplessness caused great fear in the patients, and some of them even felt desperate and desperate. In fact, smog is currently treatable, and early treatment can be very effective.
Because smog was first discovered by the Japanese in the 1960s, Japan has done more research in this area. They have carried out indirect vascular bypass surgery to treat smog with good results. Some of the young patients with smog had no sequelae after the treatment, participated in life normally, and even got into famous universities.
I studied with Mr. Yoshiharu Matsushima, a master of smog treatment in Japan, and after returning to China in 2003, I also carried out surgical treatment for smog. Through observation, I found that the results of patients in China were very encouraging after undergoing the surgery. There are patients who are comatose and have been able to go to school normally after treatment. There are also children who are mentally retarded and can communicate normally with people after surgery, and their intelligence has improved significantly. There are also some patients with hemiplegia who can walk normally after treatment.
10.Some people say that smog can be cured by itself, so is it possible for smog patients not to be treated?
Some scholars believe that smog can heal spontaneously because after the occlusion of the internal carotid artery in smog patients, the extracranial or other blood vessels can spontaneously grow to the ischemic area, and when the blood supply from the extracranial to the intracranial spontaneously growing vessels can meet the brain blood supply, then it is considered to heal spontaneously. However, it must be noted that during the long process of “self-healing”, the patient is likely to suffer from irreversible dysfunction of limb movement, speech impairment, mental decline, or cerebral hemorrhage, which has brought about serious consequences. Therefore, as doctors and patients, once smog disease is detected, they should actively go for treatment to promote early recovery to avoid sequelae.
11.How can smog be treated?
At present, it is generally believed that for smog disease, medical treatment is not effective. The main treatment for smog is surgery. Nowadays, many surgical methods have been developed to treat smog: direct vascular anastomosis, reconstruction of indirect intracranial and extracranial blood supply, cranial drilling, and large omental patching. Through observation, we believe that indirect intracranial and extracranial revascularization surgery is effective and less traumatic, so it is the most adopted surgical method.
12.What are the characteristics of this surgery?
Compared with the traditional methods of treating smoker’s disease, such as superficial temporal artery-middle cerebral artery anastomosis, the dural temporal artery fusion is an indirect bypass surgery. It is safer than traditional treatment methods because it does not destroy the original blood vessels and brain tissue. In addition, depending on the patient’s condition, we choose different treatment modalities for individualized treatment, which greatly improves the safety of the procedure. There are many patients who can find that the fused blood vessels can fully grow into the brain tissue and provide blood supply to the whole cerebral hemisphere on postoperative review.
13.Is it true that patients with any condition, regardless of gender, young or old, can undergo surgery?
Generally speaking, yes. The youngest patient we have treated is 2 years old and the oldest is 74 years old. The most severe patient has fallen into a coma and the least severe one even has no symptoms. So this surgery has a wide range of indications. As for the impact of surgery on the patient’s condition, it varies from patient to patient, and the timing of surgical intervention is different for different patients, which should be determined by the specialist.
14.Smoke disease is a bilateral vascular abnormality, so does the surgery have to be done bilaterally as well?
If the diagnosis of smog is confirmed, bilateral surgery must be performed. Otherwise, if only one side is done and not the opposite side, then only half of the brain tissue will be cured and the other half may still develop.
15.How do I know that the treatment is effective?
First of all, in terms of clinical symptoms, since smog is a chronic disease that keeps worsening, we can consider the surgery effective when the clinical symptoms are relieved or no longer progress, for example, patients with transient ischemic attack no longer produce symptoms such as numbness and weakness of the limbs, or the number and degree of symptom attacks are reduced. In patients who have had a cerebral infarction, the strength of the paralyzed limb is improved, or the speech function is restored in patients with speech impairment. In patients with cerebral hemorrhage, consciousness is restored after treatment and no further hemorrhage occurs.
Objective examination can be done by nuclear magnetic, cerebrovascular ultrasound, cerebral angiography, cranial PET and other examinations to observe that the metabolism of brain tissue is improved and the blood vessels moved to the skull by surgery supply blood to the skull, then the operation is successful.
We summarize the law and find that if those patients with cerebral ischemia, especially children, can be detected, diagnosed and treated early, the effect is very good. For patients with cerebral hemorrhage can also prevent re-occurrence of cerebral hemorrhage.
16.What do smog patients need to pay attention to in their post-operative rehabilitation?
First of all, there is nothing forbidden in the diet of smog patients. However, when eating too hot food such as noodles as mentioned above, it can cause the onset of the disease due to constant blowing, which can easily lead to hyperventilation.
Also from life, pay attention to increase and decrease clothing according to the weather, don’t get cold and don’t get stuffy. Avoid glasses with too tight legs to prevent pinching the blood vessels introduced into the skull. Pay attention to avoid trauma to the head and face, which aggravates the disease.
For patients with physical activity disorders and speech disorders, active rehabilitation should be carried out. Modern people have a new understanding of brain rehabilitation. Especially for patients with smoker’s disease, because many nerve cells are not necrotic due to ischemia, but only temporarily produce dysfunction, after surgery, due to the rich blood supply is likely to recover, then we should actively exercise, rehabilitation training. Even with hemiplegia, partial recovery can be achieved through active training. The specific ones include speech training, active limb movement training, passive training, physical therapy, etc.
Patients with smoker’s disease should also be aware that if they have a serious illness, such as surgery, special medication, or if a female patient is pregnant or has a child, they should be aware of the impact on the disease itself and ask their doctor if necessary.
What needs the family’s attention is to help the patient build up self-confidence psychologically and believe that he or she can recover. Get rid of depression, anxiety and other negative psychological effects. Encourage the patient to be more involved in social life.