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Key Clinical Message  We report a comatose patient with severe neurological deficits who was without spontaneous language or movement. He had a good response to recombinant tissue plasminogen activator (rt PA ) thrombolysis even though there were no detectable lesions on diffusion‐weighted imaging ( DWI ).  DWI  is very sensitive for diagnosing hyperacute ischemic stroke, and rt PA  thrombolysis is the best treatment. However, rt PA  thrombolysis in ischemic stroke patients without lesions on  DWI  has rarely been reported.

Hyperacute ischemic stroke without lesions on diffusion‐weighted imaging in a patient treated with rt PA thrombolysis