What are the clinical manifestations of smoker’s disease? Smoker’s disease is a cerebrovascular disease of unknown etiology, characterized by chronic progressive stenosis or occlusion of the terminal internal carotid artery and the anterior and middle cerebral arteries bilaterally, and secondary to the formation of an abnormal vascular network at the base of the skull. What are the symptoms of smog disease? Is it related to cerebral infarction, cerebral hemorrhage, epilepsy and other diseases? Here is a brief introduction to the clinical manifestations of smog. The clinical manifestations of smog disease: The clinical manifestations of smog disease differ significantly in pediatric and adult patients. The vast majority of pediatric patients present mainly with transient ischemic attack (TIA) or cerebral infarction, while about 50% of adult patients present mainly with cerebral hemorrhage and another 50% with transient cerebral ischemia or cerebral infarction. I. Transient cerebral ischemia and cerebral infarction smog 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 the latter case, ruptured bleeding from a saccular aneurysm in the ring of Willis occurs mostly in the bifurcation of the basilar artery or in the connection between the basilar and superior cerebellar arteries. In patients with smoke, the vertebrobasilar system plays an important role in the blood supply of the collateral circulation. Therefore, hemodynamic stress on the canal wall often leads to aneurysm formation in the vertebrobasilar system, and aneurysm rupture can lead to subarachnoid hemorrhage. There is increasing evidence that adult smoky patients 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 the rupture of a dilated blood vessel on the surface of the brain. Pregnancy and childbirth may increase the risk of ischemic or hemorrhagic stroke in female patients, whether treated conservatively with medications or surgically. Other neurological symptoms 1. Headache is one of the serious symptoms of smog, especially in pediatric patients, where this symptom is more common. The typical symptom is often a frontal headache or a migraine-like headache. Moreover, headache persists for more than 12 months even after surgical treatment with patching alone. Epilepsy and involuntary movements are also among the important clinical manifestations of smog, with involuntary movements mostly seen in pediatric cases. Some smog patients may show episodes of chest tightness and shortness of breath. After joint vascular bypass surgery, the symptoms of chest tightness and shortness of breath improve significantly or even disappear as the blood supply to the brain improves. How to treat smog The clinical treatment for smog includes 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. 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 smoke-like 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. It is clear that the best surgical treatment for smog is a combined bypass procedure that takes the best of both worlds. The surgery has a higher cure rate and less risk. Patients are advised to learn more and communicate with their doctors when choosing the surgery. A skilled physician will be better able to manipulate the direction of the surgery and avoid unnecessary surgical risks.