This document summarizes a presentation on the use of tissue plasminogen activator (tPA) in patients with Fisher grade IV subarachnoid hemorrhage. It describes a clinical case study of a patient and formulates a searchable question about whether tPA improves outcomes in patients with intraventricular extension of aneurysmal subarachnoid hemorrhage. It then outlines the search strategy and databases used, screening process for relevant articles, summary of identified papers in a table, and conclusions that tPA accelerates clot resolution but there is not enough evidence that it improves outcomes due to the need for larger multicenter randomized controlled trials.