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Management of acute ischemic stroke has undergone a radical change with the advent of intravenous and intra arterial thrombolysis. We would like to share our experience of the use of combined transcranial doppler and intravenous t-PA in the treatment of acute ischemic stroke; the use of which has so far not been reported in our country. The case also highlights the usefulness of diffusion perfusion imaging techniques in determining the case selection and also the success of thrombolytic treatment.