The incidence of acute ischaemic stroke with mild neurological deficits (called mild ischaemic stroke [MIS]) is increasing, and studies show that a large percentage of untreated patients have poor long-term outcomes. Many physicians do not, however, routinely treat patients with MIS with intravenous recombinant tissue plasminogen activator (rtPA)--the only thrombolytic therapy currently approved by the FDA. Here, we discuss the reasons why physicians do not treat patients with MIS and we review the studies published to date regarding the potential risks and benefits of administering rtPA in this patient population. We then provide our perspective on why patients with MIS should be treated with intravenous rtPA and we highlight the need for a randomized clinical trial to address treatment of MIS.