What are the early symptoms of smog? Smog is a very dangerous disease. It can be serious enough to cause death. But unlike headaches and fevers, the public is not familiar with the early symptoms of the disease. Many patients delay the best time for treatment because of this. What is the heritability of smog? If someone in the family suffers from smog, the probability of the immediate family suffering from smog is greater than that of the general population, so if someone in the family suffers from smog, it is best to suggest that other relatives also come and have it investigated. To prevent the risk of cerebral hemorrhage and infarction. What are the clinical manifestations of smog? Smoker’s disease is a cerebrovascular disease of unknown etiology, characterized by chronic progressive stenosis or occlusion of the end of the internal carotid artery, the anterior cerebral artery and the beginning of the middle cerebral artery, and the formation of an abnormal vascular network in the skull base. The clinical presentation of smoker’s disease differs significantly in pediatric and adult patients. The vast majority of pediatric patients present primarily with transient ischemic attack (TIA) or cerebral infarction, while approximately 50% of adult patients present primarily with cerebral hemorrhage and the other 50% with transient cerebral ischemia or cerebral infarction. I. Transient cerebral ischemia and cerebral infarction Smoke disease often leads to cerebral ischemia in the internal carotid artery supply area of the brain, especially in the frontal lobe. As a result, most patients will exhibit frontal lobe signs and symptoms, such as dysarthria, aphasia, or hemiparesis. Smoker’s disease can also have other atypical symptoms such as syncope, lower extremity bradykinesia, visual symptoms or involuntary movements, which are more likely to occur in pediatric cases. Some pediatric cases develop mental retardation due to frontal lobe cerebral ischemia or infarction. A few adult cases may have cognitive impairment, such as memory loss, irritability, or anxiety. Patients with these symptoms are often misdiagnosed with psychiatric disorders such as schizophrenia, depression, or personality disorders. Cerebral ischemic attacks in pediatric patients are often triggered by hyperventilation, such as crying or playing a wind instrument. Therefore, if a sudden weakness or numbness of one limb occurs in children and gets better for a short period of time, this should be considered as a possibility of smog, and a specialist examination such as magnetic resonance angiography (MRA) should be done at the hospital as soon as possible. Second, intracranial hemorrhage will occur in about 50% of adult smog patients. There may be two main causes of their bleeding: ruptured bleeding from dilated, brittle blood vessels, or ruptured bleeding from a cystic aneurysm in Willis’ ring. In the former, ruptured vessel hemorrhage may result from pressure on the vessel wall due to its prolonged hemodynamics and occurs primarily in the basal ganglia region, thalamus, or periventricular areas, often in combination with ventricular hemorrhage. In some patients, cerebral angiography may reveal aneurysm formation on the vessel. In patients with smoke, the vertebrobasilar system plays an important role in the supply of blood to the collateral circulation. And ruptured aneurysms can lead to subarachnoid hemorrhage. There is increasing evidence that adult smokers can develop subarachnoid hemorrhage on the surface of the brain even in the absence of an aneurysm. In rare cases, adult smokers can also bleed from a ruptured dilated vessel on the surface of the brain. In women, pregnancy and childbirth may increase the risk of ischemic or hemorrhagic stroke, whether treated conservatively with medication or surgically. Third, headache is one of the serious symptoms of smog, and it is more common, especially in pediatric patients. The typical symptom is often a frontal headache or a migraine-like headache. Moreover, headaches persist for more than 12 months even after surgical treatment with patching alone. Fourth, epilepsy and involuntary movements are also one of the important clinical manifestations of smog disease, and involuntary movements are mostly seen in children cases. Fifth, some patients with smog may show episodic chest tightness and shortness of breath. After joint vascular bypass surgery, with the improvement of blood supply to the brain, the symptoms of chest tightness and shortness of breath also improve significantly or even disappear. How to treat smog? The clinical treatment for smog is a combination of direct bypass surgery, indirect bypass surgery and combined vascular bypass surgery. Direct bypass surgery is to re-establish new blood flow channels to ensure adequate cerebral blood flow, and to rapidly improve cerebral blood supply by anastomosing the intracranial and extracranial vessels through direct bypass. Indirect bypass surgery, or patching surgery, is the application of muscle and meningeal tissue rich in extracranial blood supply to the surface of the brain inside the skull. In order to relieve the inadequate blood supply to the intracerebral arteries, the blood flow in the brain is improved by establishing a channel for blood supply from normal blood vessels outside the brain to the brain, and the improved blood supply reduces the need for smoky vessels, thus reducing the patient’s risk of reoccurring cerebral ischemia and cerebral hemorrhage. Combined vascular bypass surgery is based on the summary of the advantages and disadvantages of the two traditional procedures, bypass + patching in one operation, on the basis of bypass multi-factor patching, the establishment of multiple blood flow pathways, can provide rich blood for the patient’s brain tissue, this can have the advantages of patching surgery (the brain blood supply range is larger) and give the time needed for the growth of new blood vessels (by the direct bypass vessels to maintain normal blood supply). This avoids the development of a stroke before the neovascularization occurs. This is superior to direct bypass and indirect bypass alone. Therefore, the early symptoms of smog are also very serious. It is important to intensify treatment to avoid the hidden risks of cerebral hemorrhage, cerebral ischemia, and cerebral infarction. If left untreated, early childhood smog may affect the child’s intelligence, in which case it is difficult to restore normal intelligence even after a smog bypass surgery.