Objective To explore the influence factors of early neurological deterioration （END） after intravenous thrombolysis with alteplase and the predictive value of gaze face arm speech time （G-FAST） score in patients with acute ischemic stroke （AIS）. Methods A total of 219 patients with AIS treated with alteplase for intravenous thrombolysis in the Second Affiliated Hospital of Shenyang Medical College from January 2016 to January 2019 were retrospectively analyzed. The National Institutes of Health Stroke Scale （NIHSS） was used to evaluate the incidence of END after intravenous thrombolysis with alteplase. Logistic regression was used to analyze the influencing factors of END， and receiver operating characteristic （ROC） curve was used to analyze the value of each indicator to predict END. Results Among the 219 patients， 43 patients had END， accounting for 19.63%. Age ≥ 60 （OR=1.035，95%CI：1.003-1.236）， history of atrial fibrillation （OR=1.925，95%CI： 1.313-2.685）， coma （OR=2.031，95%CI：1.340-3.026）， NIHSS score ≥ 10 （OR=1.368，95%CI：1.167-2.361） and G-FAST score ≥ 3 （OR=1.509，95%CI：1.368-3.165） were independent risk factors for END （P＜ 0.05）. G-FAST score， NIHSS score and the area under ROC curve combined predicted by them were 0.768， 0.733 and 0.897， respectively. Conclusions There are many factors influencing the occurrence of END after intravenous thrombolysis with alteplase. G-FAST scale has certain predictive value for END.