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Abstract: Smog syndrome, also known as smog, is a cerebrovascular disease characterized by an abnormal vascular network at the base of the skull, which can lead to headache and slurred speech. In this case, the patient was admitted to the hospital with the complaint of “sudden onset of slurred speech for 13 days”, and a whole brain angiogram was performed after admission to confirm the diagnosis of smog. After completing the relevant tests, he underwent right superficial temporal artery-middle cerebral artery bypass surgery combined with temporal muscle patching.
Basic information】Male, 44 years old
Type of disease】Smoke disease
Hospital】Liaoning Provincial People’s Hospital
Date of consultation】April 2021
Treatment plan】Surgical treatment (right superficial temporal artery-middle cerebral artery bypass surgery combined with temporal muscle patching) + medication (furosemide injection, olanzapine injection)
[Treatment period] 14 days of hospitalization, 1 month of postoperative review
Treatment effect】Cerebral blood flow improved, upper limb muscle strength restored
I. Initial consultation
The patient was admitted to the hospital with the complaint of “sudden onset of slurred speech for 13 days”. At the time of admission, the patient had clear consciousness, speech impairment, grade 5 muscle strength of the right limb, grade 0 muscle strength of the left upper limb, and grade 3 muscle strength of the left lower limb, and the head MRI showed a large infarct in the right frontoparietal lobe and multiple infarcts in the brain. MRA showed that the right middle cerebral artery was mostly unrevealed, the superficial temporal artery entered the skull, and the branches were sparse and slender. Therefore, the diagnosis was “smog disease”.
II. Treatment history
The family and the patient were very anxious when they learned that it was smog, because the patient was born with poor vascular condition and there would be a risk of cerebral infarction later. After learning that surgery could be done to improve the symptoms, the patient and family actively cooperated, and after perfecting the preoperative examination, the patient underwent right superficial temporal artery-middle cerebral artery bypass surgery combined with temporal muscle patching, i.e., the right superficial temporal artery was isolated, and the frontal branch of middle cerebral artery was reached through the temporal muscle, and end-lateral anastomosis was performed, while the temporal muscle was patched to the surface of cerebral cortex. The operation went smoothly, and postoperatively, furosemide injection was given to control blood pressure and olanzapine injection to nourish the nerves as symptomatic treatment.
III. Treatment effect
After the operation, the patient was discharged from the hospital after the removal of stitches from the head as blood was seen to enter the middle cerebral artery via the superficial temporal artery and there were no adverse complaints after the operation. Six months later, the patient was admitted to the hospital for a follow-up examination, with clear consciousness, grade 5 muscle strength of the right limb, grade 2 muscle strength of the left upper limb, and grade 3 muscle strength of the left lower limb, all of which had improved, and the right frontoparieto-occipitotemporal hypoperfusion area of the head MRI 3D-ASL had been reduced, but the speech function had not been fully recovered, and the patient was advised to continue rehabilitation exercises.
IV. Notes
We are glad that the patient was discharged from the hospital after improvement of treatment. The patient should continue rehabilitation exercises after going home. In addition, since it takes 3 months to 6 months for the bypass vessels to be fully formed, brain hemorrhage and cerebral infarction can easily occur during this period, so it is important to eat a scientific diet, mainly high protein and liquid food, and eat more light and easily digestible food to prevent constipation, so as not to cause sudden high blood pressure. Also pay attention to daily monitoring of blood pressure and blood sugar changes, avoid bad habits, do not stay up too late, do not smoke and drink alcohol, pay attention to temperature changes, avoid colds. Patients should have the confidence to overcome the disease and strengthen functional exercise. They can walk slowly on the ground 3 days after the operation, and review the vascular condition of the head 1 month after the operation.
V. Personal insight
Smoke disease” is a chronic progressive vascular occlusive disease of cerebral arteries, and during whole brain angiography, the small vessels forming these cerebral vessels look like “smoke clusters” on the angiographic image, so it is called “smoke disease”. Smoggy disease”. If this patient could be detected and treated with surgery at an early stage, the consequences of aphasia and loss of muscle strength, which should not have been suffered by him, could have been avoided, and 44 years old is the best age to do business. Therefore, it is recommended to add the sequence MRA to all first MRI, which can screen for many vascular diseases, in addition to smog, and aneurysms and other diseases.