Safety of Intravenous Thrombolytics in Stroke on Awakening

Inclusion Criteria: * Age greater or equal to 18 years, and lower or equal to 80 years. * Signs and symptoms of acute ischemic stroke. * Symptoms present upon awakening. * Arriving to the Emergency Department within 4.5 hours of awakening. Treatment with IV tPA must be initiated prior to 4.5hours from waking up. * NIHSS \>3 * A non-contrast head CT without hemorrhage and without hypodensity more than 1/3 of the middle cerebral artery (MCA) territory; or MRI demonstrating no hemorrhage, and with a diffusion-weighted imaging (DWI) lesion no greater than 70 mL and FLAIR without a well defined hyperintense lesion that is more than 1/3 of the MCA territory. * Pre-morbid modified Rankin score of 0 or 1. Exclusion Criteria: * Rapidly improving deficit to an NIHSS less than 3. * Sustained systolic blood pressure greater than 185 mmHg or diastolic blood pressure greater than 110 mmHg despite treatment. * Glucose less than 50 mg/dL. * Stroke or head trauma within last 3 months. * History of intracranial hemorrhage. Symptoms of subarachnoid hemorrhage. * Major surgery within 14 days. * Gastrointestinal (GI)/Genito-urinary (GU) hemorrhage within 21 days. * International normalized ratio (INR) \> 1.7. * Heparin within 48 hours with an elevated activated partial thromboplastin time (aPTT). * Platelet count less than 100,000. * Presumed septic embolus or suspicion of bacterial endocarditis. * Suspicion of aortic dissection. * Use of anticoagulants such as dabigatran, rivaroxaban, apixaban, enoxaparin. * Pregnant or lactating women. * Known allergy or sensitivity to tPA.