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Recombinant Tissue Plasminogen Activator (rTPA) is the standard of care for treatment of acute ischemic stroke. Nevertheless, its widespread use in Egypt is hindered by many factors. We report on the first case of acute ischemic stroke to be treated with rTPA at our University hospitals. She received rTPA 4 h and 20 min after the onset of symptoms despite the occurrence of stroke inside the hospital and the availability of rTPA. The patient showed partial improvement after 3 months. We hope that public and medical staff awareness as well as our developing experience relative to treatment of acute ischemic stroke would improve over time allowing for avoidance of long-term suffering of these patients.