Intracerebral hemorrhage (ICH) after thrombolytic treatment for acute myocardial infarction (AMI) is a serious complication causing significant morbidity and mortality. Drainage of the haematoma by craniotomy is associated with poor outcome. We present a patient who received tissue plasminogen activator (t-PA) for acute myocardial infarction; he subsequently developed an ICH with ventricular system extension. The patient was managed by insertion of an external ventricular drain. The hemorrhage was successfully evacuated by insertion of the external ventricular drain. This was unexpected as ICH are usually viscous and difficult to aspirate in the acute phase. This suggests that ICHs following thrombolytic therapy remain liquid for up to 10 h. External ventricular drains can be used in the management of patients with ICH complicating thrombolytic therapy for management of acute myocardial infarction or ischemic stroke. This reduces the need for craniotomy and associated morbidity and mortality.