Reversal of the reversed ‘Robin Hood syndrome’ after superficial temporal-Middle cerebral artery bypass for severe intracranial stenosis

Abstract

Background: Intracranial arterial stenosis is a common cause of ischemic stroke. Recent attempts with intracranial stenting and superficial temporal-middle cerebral artery (STA-MCA) bypass failed to show benefit. Perhaps, better strategies are needed for selecting suitable patients. Acetazolamide-challenged single photon emission computed tomography (SPECT) can demonstrate reversed Robin Hood syndrome (RRHS) due to intracranial steal phenomenon and identify high-risk patients.

Methods: We describe the clinical and SPECT findings of RRHS.

Results: In our patient with severe and symptomatic severe stenosis of the right MCA, STA-MCA bypass resulted in complete resolution of RRHS.

Conclusion: STA-MCA bypass surgery should be considered a possible option in patients with severe stenosis of intracranial internal carotid artery or MCA in carefully selected patients.

Keywords:

• Intracranial stenosis
• superficial temporal-middle cerebral artery bypass
• vasodilatory reserve
• SPECT

Disclosure statement

None of the authors declare any conflict of financial interest related to this manuscript.