Several sympathomimetic agents have been associated with ischemic and hemorrhagic stroke. Ephedrine, a sympathomimetic drug that has a high potential for abuse and can be readily obtained without a prescription in unrestricted quantities, has rarely been associated with stroke. We report ephedrine-related stroke in three patients. One patient developed a thalamic infarct after ingesting known quantities of ephedrine as street-purchased "speed" for weight loss. Two patients had fatal intracranial hemorrhages after ingesting unknown quantities of ephedrine; one of them had a history of drug abuse, and one lacked a history of ephedrine use or drug abuse. Ephedrine appears to predispose to both ischemic and hemorrhagic stroke. The mechanisms responsible for the different cerebrovascular complications remain to be proven. Restriction of ephedrine availability should be considered.