Abstract Introduction In acute stroke, the diagnosis of reversed Robin Hood syndrome (RRHS) by transcranial Doppler (TCD) helps to identify patients at high risk for neurological deterioration. Report A patient with left intracranial internal carotid artery (ICA) dissection and concomitant inadequate collateral circulation suffered from recurrent ipsilateral ischaemic symptoms, not prevented by the best medical treatment. TCD showed an RRHS. Stenting of ICA could restore an adequate flow with disappearance of the RRHS and prevention of further episodes. Discussion An invasive emergency treatment should be considered in those stroke patients in which TCD detects an inadequate haemodynamic status.