Introduction: The cerebrovascular diseases significantly affect mortality and morbidity in the geriatric patient group. Approximately 85% of acute cases present as ischemic stroke. The primary goal of treatment is to restore and maintain adequate perfusion. In this 2 case reports, we aimed to compare effect of thrombolytic treatment in two geriatric patients who had acute ischemic stroke. Case: Case 1: A 69-year-old female patient with a diagnosis of HT and DM was brought to the emergency room with GCS of five. She was intubated and transferred to intensive care unit. Diffusion restriction was observed in the right thalamus, right occipital, and left cerebellum in DWI MRI. TPA was planned for the patient, but her relatives refused the treatment. The enoxiparin 2x0.6 IU and 100 mg ASA treatments were started. No change was detected in the control MRI. The patient died due to secondary causes after a long intensive care stay. Case 2: A 96-year-old female patient was brought to the emergency department with complaints of weakness in left upper extremity, speech disorder and weakness. Her GCS was 10, blood pressure: 177/88 mmHg and hearth rate was 99/minute. The DWI MR showed diffusion restriction around the right lateral ventricle. She was intubated due to deterioration of consciousness. The thrombolytic treatment was administered at the 4th hour of event. The patient was extubated on the 2nd day of hospitalization with the GCS of 15 and transferred to the neurology clinic. Discussion: The cerebrovascular diseases are the second leading cause of death and major cause of disability in the world. IV thrombolysis remains a proven medical treatment but timeframe for treatment is still narrow and the majority of patients with ischemic stroke are unable to receive thrombolysis. In this case early use of thrombolytic treatment improved neurological recovery and reduced disability with satisfactory result. [ABSTRACT FROM AUTHOR]