PIP: 2 cases of cerebrovascular complications of oral contraceptives (OCs) and results of a literature review are described in the hope of alerting other practitioners to the need for careful patient evaluation before OCs are prescribed. A 32 year old multipara with a 2 year history of Gynovlane use suffered a complete occlusion of the carotid artery, probably of embolic origin. A 20 year old mother of 1 child with a 1-year history of Gynovlane use was diagnosed as suffering an ischemic vascular accident in the area of the left ophthalmic artery. Cerebral vascular accidents appear to be rare in OC users; about 1 in 10,000 users on a worldwide basis is afflicted, but unfortunately about 5-10% are fatal. Women of any age may be affected, but the incidence increases in women over 35 years, whose mortality rate is 4 times greater. White women according to 1 author are more at risk than black women. All types of pills may be involved, but the risk appears to be partly a function of the presence and dosage of estrogen. Cerebrovascular accidents have become rare since the advent of lower dosed pills. The duration of pill use before the occurence of the accident varies, but venous thromboses appear to occur earlier than arterial accidents. Factors favoring occurrence of cerebrovascular accidents in women using pills depend on the type of accident. Age, smoking, hyperlipidemia, surgical interventions, and a history of migraines are implicated in arterial thromboses. Surgical interventions, prolonged immobility due to fracture, and preexisting venous conditions are implicated in venous thromboses. The severity of hormone-induced cerebrovascular accidents confers great importance on prevention. No test exists to identify women at highest risk, so that prevention requires careful screening of OC candidates for risk factors. Treatment of cerebrovascular accidents and their sequelae is usually based on anticoagulants and heparin. Systematic functional rehabilitation is necessary in cases of invalidism. Termination of OC use is necessary in all cases at the least sign of trouble.