Emergency intravenous thrombolytic therapy saves stroke patients. However, unexpected circumstances still occur. Here we report two patients who received intravenous thrombolytic therapy for acute ischaemic infarction and suffered brainstem haemorrhage within 3 hours of thrombolysis. Both patients had left middle cerebral artery ischaemic infarction but not basilar artery infarction. The haemorrhages were concurrent with extremely high blood pressure. Extremely high blood pressure during thrombolysis not only increases possibility of haemorrhagic transformation of ischaemic infarction but also chance of intraparenchymal haemorrhage. (Hong Kong j.emerg.med. 2014;21:112-115)
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