Reversal of the 'reversed Robin Hood syndrome' in severe intracranial stenosis after enhanced external counterpulsation therapy

A 59-years old Chinese woman presented with recurrent episodes of transient left hemiparesis for 1-month. Each episode lasted 5-10 minutes. She was on regular medications for hypertension and dyslipidemia. Her neurological examination was unremarkable. Magnetic resonance (MR) imaging revealed an old left posterior watershed infarct. However, MR angiography (Figure-1) revealed severe stenosis of both middle cerebral arteries (MCA).