Thrombolytic therapy with recombinant tissue plasminogen activator (rt-RA) is now an accepted treatment for acute ischemic stroke if the patient can be treated within 3 hours of onset of symptoms, and if the clinical presentation justifies use of the medication, and if there are no contraindications to the use of rt-PA. The non-contrast CT brain scan is mandatory to rule out an intracerebral hemorrhage, evidence of subarachnoid hemorrhage, or significant evolution of a large cerebral infarction. The later the patient is treated, within the 3-hour therapeutic window, the less likely there is to be clinical benefit of the treatment and the greater risk of hemorrhagic transformation of the cerebral infarction with potentially catastrophic consequences. There is approximately a 30% greater chance of full recovery from the stroke, at 3 months out from the infarct, with rt-PA compared to no rt-PA. On the other hand, there is a 6.4% risk of symptomatic intracerebral hemorrhage, within 36 hours, associated with the use of rt-PA compared to a 0.6% risk in the placebo group. The greater the neurological deficit at the time of presentation and the greater the evolution of the infarct by the admission CT brain scan, the greater the risk of intracerebral hemorrhage complicating the use of rt-PA.