Reversed Robin Hood syndrome visualized by CT perfusion

Reversed Robin Hood Syndrome (RRHS) was first described in 2007 as a cause of worsening neurological deficit in the setting of an acute ischemic event. RRHS is the shunting of cerebral blood flow to nonstenotic vascular territories due to impaired vasodilation bought on by hypercapnia. A 77 year old lady presented with acute onset left hemiparesis and an exacerbation of her underlying chronic obstructive pulmonary disease (COPD). CT angiography and perfusion visualized RRHS and appropriate treatment was initiated. Treatment strategies for RRHS differ considerably to those for acute ischemic stroke. Choosing the correct treatment strategy is decisive for good clinical outcome.