We describe 2 patients with intracranial hemorrhage after ingestion of diet pills containing phenylpropanolamine (PPA) in combination with caffeine. The first patient had bilateral simultaneous intracerebral hemorrhages, and the second had a subarachnoid hemorrhage. PPA is widely used most often without prescription and causes intracranial hemorrhage more often than has been realized. The mechanism may be induction of a transient hypertensive crisis.