Cerebrovascular diseases are a group of brain dysfunctions related to disease of the blood vessels supplying the brain, and characterize by high incidence, high morbidity and high mortality. Acute cerebrovascular disease is also known as stroke. Elderly stroke patients have poor prognosis than those young. Standardized diagnosis and treatment of stroke are helpful to reduce the mortality and morbidity. Drug therapy is one of the main options in the treatment of the disease. However, the elderly patients have the characteristics of slow metabolism, poor elasticity of blood vessels and commonly co-existing multiple organ disorders. In this paper, we summarized and overviewed the rational use of medication for acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH), the most common types of cerebrovascular diseases in the elderly.