A stroke is "acute neurologic dysfunction of vascular origin with abrupt (within seconds) or at least fast (within hours) onset of symptoms and signs correlating to the involvement of specific regions in the brain." Strokes may be either ischemic or hemorrhagic. This research set out to compare NIHSS scores before and after rTPA, as well as to look at other variables that could have an effect on the result of rTPA. Methods: Fifty patients who had had an acute cerebrovascular stroke and been treated with RTPA were included in this retrospective analysis. Electrocardiogram (ECG), Echocardiogram (Echo), and Doppler ultrasound of the carotid arteries will be performed on all patients. Standard blood tests include a complete blood count (CBC), a lipid profile, a random blood sugar and glycosylated haemoglobin, and a hematocrit measurement (Hba1c). Early neurological progress; the results. AKA: high blood pressure. Ratio normalised on a global scale; abbreviated INR. Interquartile range (IQR) The M-RS is the modified Rankin scale. What we call the "stroke scale" at the National Institutes of Health. On bivariate analysis, hemorrhagic transformation was linked to factors such as a prior history of hypertension (8(88.9%)/1(11.1%), p= 0.034*), a higher NIHSS at presentation (16(13.5-21.5) against 13(11-16), p=0.025*), and a higher NIHSS after 24 hours (20(15-25) versus 10(7-15), p=0.000**). Initial National Institutes of Health Stroke Scale (NIHSS) was an independent predictor, with an increased risk of hemorrhagic transformation of 1.223% (95% CI 1.030% to 1.451%) (p=0.021) for each additional unit, and hypertensive patients tended to experience hemorrhagic transformation (AOR= 9.529% (95% CI 0.936% to 97.56%), p=0.058). When patients are properly chosen, intravenous rtPA is effective. There is no significant difference in the results in the first 3 hours versus extra 1.5 hour. It works just as well in the frontal as it does in the backal circulation. The National Institute of Health Stroke Scale (NIHSS) is an excellent clinical instrument for predicting the severity, speed of recovery, hemorrhagic transformation, and death of stroke.