Amphetamine use in certain parts of the United States has risen dramatically. Methamphetamine, the most-common illicitly abused type of amphetamine, can be inhaled, injected intravenously, or smoked. It is a potent sympathomimetic that may lead to vascular events including myocardial infarction and stroke. Because of the demographics of drug use, these potentially devastating events usually occur in relatively young patients. The pathophysiology of stroke related to amphetamine use is multifactorial. Elevation in blood pressure, vasculitis, or other vascular toxicity are postulated as major mechanisms. Four cases of stroke associated with the use of methamphetamine, all occurring in patients ranging in age from 29-45 years, are described. Methamphetamine use appears to be a risk factor for the development of stroke. The rise in methamphetamine use will undoubtedly result in increased Emergency Department admissions with clinical presentations very similar to those of cocaine intoxication.