Smoker’s disease is a chronic progressive cerebrovascular occlusive disease of unknown cause, mainly manifested by unilateral or bilateral narrowing or occlusion of the distal middle cerebral artery and proximal anterior cerebral artery of the internal carotid artery with smoky, small blood vessel formation at the base of the brain and soft meninges. Clinical manifestations include cerebral ischemia, cerebral hemorrhage and epilepsy. Smoldering disease differs from smoldering syndrome and smoldering phenomenon, which are caused by certain definite causes, such as atherosclerosis, post-radiation therapy, meningitis, sickle cell disease, tumor, trauma, neurofibromatosis, Down syndrome, and spontaneous internal carotid artery occlusion. The etiology is not well understood. Most cases are associated with congenital factors, and some cases are found to be associated with bacterial, viral, tuberculosis, and schistosomal infections, manifesting as progressive stenosis and occlusion of the trunks of the terminal internal carotid artery, anterior cerebral artery, and middle cerebral artery in bilateral symmetry, with the formation of extensive surrounding collateral compensatory vessels, thus constituting an extensive network of anomalous vessels at the base of the brain. How is the diagnosis of smoker’s disease made? I. Outpatient inquiry of medical history and symptoms 1. Past and family history. The doctor asks if there is any history of head trauma, nonspecific arteritis, epilepsy, etc. Are there any members of the family with similar disease. 2. Cerebral ischemic symptoms. Child patients mainly show symptoms of cerebral ischemia, such as transient ischemic attack, ischemic stroke and cerebrovascular dementia, etc. Headache, convulsions, mental retardation, abnormal sensation and episodic hemiparesis are common. 3.Symptoms of cerebral hemorrhage. Adult patients mostly show symptoms of cerebral hemorrhage, such as intracerebral hemorrhage, intraventricular hemorrhage and subarachnoid hemorrhage, three types of hemorrhage are common. Most of them have no prodromal symptoms, sudden onset, headache, vomiting, cranial hypertension, and focal signs such as epilepsy, aphasia and hemiparesis. A few die from more bleeding or severe cerebral vasospasm. 4.Neurological examination. In the case of neurology, there is generally no impairment of consciousness, bilateral pupils are equal in size and sensitive to light reflex; in severe cases, there may be sensory impairment, hemiparesis, and positive Babinski’s sign on one or both sides. Second, special technical examination 1, cerebrovascular imaging examination. Cerebrovascular imaging is to inject contrast into the blood vessels and use special examination equipment to image the blood vessels to observe whether there is narrowing and blockage, which generally has no major impact on the body. It mainly includes DSA, MRA and CTA, among which DSA (also known as whole brain angiography) is used to clarify the diagnosis, the degree of stenosis and collateral circulation, etc. 2.Brain perfusion imaging. It mainly includes MRI, CT perfusion and ECT, etc. Perfusion imaging is done by adding contrast developer to the blood, and when the developer passes through the intracranial vessels, CT or MRI is used to image the cranial brain and perform data analysis and processing, which can show the blood vessels and surrounding brain parenchyma more clearly. When a vascular lesion occurs, the blood vessel is blocked and shows degeneration and necrosis of brain tissue in the blood supply area. It can reflect the hemodynamic and metabolic conditions from the microcirculation level, and can make an objective assessment of the condition. 3.High-resolution MRI (HRMRI). High-resolution MRI is used for non-invasive examination of carotid stenosis, mainly ultrasound, CT angiography (CTA), magnetic resonance angiography (MRA) and high-resolution magnetic resonance imaging (HRMRI). HRMRI can not only show the lumen, but also clearly show the pathological changes of the arterial wall and atherosclerotic plaque, such as lipid, hemorrhage, calcification and rupture of the fibrous cap in the plaque. Early detection of patients with fragile and unstable plaques is of great importance for predicting the prognosis of patients and selecting appropriate treatment plans. Studies have confirmed that HRMRI has high sensitivity and specificity for the diagnosis of all types of carotid atherosclerosis. In addition, HRMRI shows a cross-section of the carotid artery, so the degree of stenosis can be determined not only by the diameter of the lumen but also by its area. Transcranial ultrasound Doppler (TCD) is a non-invasive, low-risk and inexpensive test that can evaluate the intracranial vascular condition and the effect of surgery non-invasively; TCD is non-invasive, painless and inexpensive for patients; it is comprehensive, repeatable and reliable, and can perform real-time dynamic observation and long-term dynamic monitoring; it is small in size, easy to examine, and has good complementarity with cerebral angiography. Complementarity. It can provide important hemodynamic information that cannot be measured by MRI, DSA/SPECT and other imaging techniques. It has important significance in the evaluation of cerebrovascular disorders and differential diagnosis. Brain CT is a method of examining the cranial brain through CT. It is used to determine whether there is new intracranial infarction and hemorrhage in patients with smoldering disease after surgery, to assess the level of rehabilitation of patients after surgery, and to guide the later treatment and care.