Vijay K Sharma1,2, Ning Chou3, Arvind K Sinha4. 1. Division of Neurology, National University Health System, Singapore, Singapore. 2. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 3. Divison of Neurosurgery, National University Health System, Singapore, Singapore. 4. Department of Diagnostic Imaging, National University Health System, Singapore, Singapore.
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.
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 RobinHood 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.