Reversed Robin Hood Syndrome in a Patient With Luxury Perfusion After Acute Ischemic Stroke

A 49-year-old man presented with a 1-day history of multiple transient episodes of right-sided weakness. The episodes were stereotypical, precipitated by exertion, and lasted 5 to 10 minutes. He denied any chest pain, palpitation, headache, or injury. He was a chronic smoker (40 cigarettes per day for 20 years) and denied any past or family history of hypertension, diabetes mellitus, dyslipidemia, stroke, or ischemic heart disease.On arrival, he was fully conscious and oriented and had regular pulse (65 bpm), and blood pressure (145/90 mm Hg). Some word-finding difficulties and mild right-sided weakness (power, Medical Research Council grade 4) were noted (National Institute of Health Stroke Scale score, 4 points). Magnetic resonance imaging of the brain (Figure 1A) revealed multiple areas of restricted diffusion in the left middle cerebral artery (MCA) territory. Although the classic ultrasonographic findings were not seen on carotid duplex, the absence of significant atherosclerotic plaques …