A 49-year-old woman with an acute ischemic stroke was treated by the intravenous administration of tissue plasminogen activator within 2 h of symptom onset. She complained of severe upper thoracic back pain the following day. Progressive paraparesis was detected on the third admission day. Spinal MRI demonstrated an acute anterior subdural hematoma from the C7 to T2 level. An urgent laminectomy was performed. Neurologists must be aware of the possibility that neck or back pain after thrombolysis for ischemic stroke may be the first presenting symptom of spinal hematoma.