Patient description: A 62-year-old African-American man presented with left upper and lower extremity weakness, associated with dark visual spot in right eye, right facial numbness, facial drop and slurred speech. He denied dyspnea, headache, palpitations, chest pain, fever, dizziness, bowel or urinary incontinence, loss of consciousness. His medical history was significant for hypertension, hyperlipidemia and hypothyroidism. He smokes cigarette 1 pack per day for 40 years and alcohol consumption of 5 to 6 beers per week. He is not aware about his family history. He is using Levothyroxine, Atorvastatin and HTCZ. His vital signs were stable in the primary evaluation. Left-sided facial droop, dysarthria, and left-sided hemiplegia were seen in the physical exam. His National Institutes of Health Stroke Scale (NIHSS) score was calculated as 7. Initial CT angiogram of head and neck reported no acute intracranial findings. Intravenous recombinant tissue plasminogen activator (t-PA) was administered as well as high-dose statin therapy. The patient was admitted to the intensive care unit to be monitored for 24 hours. MRI of the head revealed an acute 1.7-cm infarct of the right periventricular white matter and posterior right basal ganglia.

Clinical trial eligibility criteria: eligible ages (years): 22.0-82.0,  Stroke, Acute Age 22 to 82 years old inclusive 2. Patient receiving IV rt-PA using standard guidelines 3. NIHSS score ≥ 7 and ≤ 20 (right hemisphere) or ≥ 7 and ≤ 24 (left hemisphere) at the time of randomization 4. Pre-stroke mRS 0-1 5. Able to begin endovascular phase of hypothermia within 2 hours of tPA completion 6. Written Informed Consent, signed and dated by the patient (or patient's authorized representative)  Etiology other than ischemic stroke 2. Item 1a on NIHSS > 1 at the time of randomization 3. Clinical symptoms consistent with brainstem or cerebellar stroke 4. Classic lacunar syndrome with imaging confirmation of small deep ischemia, but randomization will not be delayed for neuroimaging other than initial scan to hemorrhage 5. Known contraindications to hypothermia, such as known hematologic dyscrasias that affect thrombosis (cryoglobulinemia, Sickle cell disease, serum cold agglutinins), or vasospastic disorders such as Raynaud's or thromboangiitis obliterans 6. Known co-morbid conditions that are likely to complicate therapy in the opinion of the investigator, e.g., i. Heart failure (NYHA class III and IV)* ii. Uncompensated arrhythmia iii. Severe Liver disease iv. History of pelvic or abdominal mass likely to compress inferior vena cava v. IVC filters vi. HIV positive vii. Clinically active hypo or hyperthyroidism viii. Renal insufficiency likely to impair meperidine clearance ix. Chronic ethanol abuse x. History of HIT (heparin induced thrombocytopenia) 7. Pregnancy (All women of child-bearing potential must have a negative pregnancy test, urine or blood, prior to therapy.) 8. Medical conditions likely to interfere with patient assessment. 9. Known allergy to meperidine or buspirone 10. Currently taking or used within previous 14 days MAO-I class of medication. 11. Life expectancy < 6 months 12. Not likely to be available for long-term follow-up 13. Use, or planned use, of intra-arterial thrombolysis, mechanical clot removal, or other experimental or approved acute therapy for this stroke event 14. Chest radiograph or clinical presentation suggestive of pneumonia or clinically significant pulmonary edema at baseline. 15. Temperature upon admission greater than or equal to 38°C