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Background: Rapidly Improving Stroke Symptoms (RISS) is a controversial exclusion criterion for tPA for acute ischemic stroke (AIS). Prior studies suggest 4-44% of AIS patients eligible are not given tPA solely because of RISS and their outcome is not invariably benign. In 2013 The Re-examining Acute Eligibility for Thrombolysis (TREAT) Task Force published new criteria for defining RISS.

Objectives: To estimate frequency and outcome of RISS based on TREAT criteria in a prospective cohort of consecutive AIS patients.

Methods: Serial NIH Stroke Scales (NIHSS) for AIS patients admitted within 4.5 hrs of symptom onset were performed every 20 (±5) minutes until a treatment decision (tPA vs no tPA) was made, independent of the study. Improvement was calculated as the difference between baseline NIHSS (bNIHSS) and treatment decision NIHSS (tdNIHSS). Per TREAT criteria, RISS was defined as improvement …