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A 72 year man with history of brain stem cavernous malformation and TIA was admitted with acute ischaemic stroke and NIHSS score of 10. Initial CT scan of brain did not show any established infarct or haemorrhage. After discussion with patient and family patient received intravenous thrombolysis and 24 hours post thrombolysis NIHSS had improved to 8. He participated in rehabilitation with good recovery and functional outcome in left arm.