A case study approach was adopted to analyze the pharmacological management of clinical cases of acute ischaemic stroke subsequent to initial treatment with medicinal products that were administered in the acute setting. The study was conducted in a tertiary care University Hospital, Clinical Centre, Kragujevac, Serbia, during August 2013, where the rationale of medicines prescribing was evaluated in eight cases. The administered medicines were assessed whether they were used in accordance with the recommendations by the National Institute of Clinical Excellence (NICE) guidelines. Appropriate medicines such as aspirin were noted to be used in the management of the most cases and this was in conformation to these guidelines. Deviations from these recommendations included the use of vitamin supplements with antioxidant properties, iron supplements, antibiotics, benzodiazepenes, ranitidine, aminophylline and risperidone. An appropriate indication for administration of these medicines was not established. Additionaly, this study showed that there were instances where an inappropriate route of administration was used. All observed deviations from the recommended guidelines were not justified, and thus led to the inappropriate use of medicines and suboptimal care. These can be minimized by clear and precise diagnostic data and conformity to the NICE or other available national guidelines.