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Cannabis is the most commonly abused illicit drug and is often considered innocuous. However, cases of acute onset neurologic dysfunction occurring in relation to cannabis use have been described and corresponding cerebral imaging studies have documented focal ischemic changes and vessel abnormalities.This article reviews all reported cases of presumed cannabis related cerebral ischemic events in the medical literature, as well as pertinent human and animal experimental studies on the cardiovascular and cerebrovascular effects of cannabis.Cannabis use seems to have been causally related to several instances of cerebral ischemia and infarction. Proposed etiologic mechanisms have included cerebral vasospasm, cardioembolization, and systemic hypotension with impaired cerebral autoregulation, but most of the available data points to a vasospastic process. The exact relation of cannabis to cerebrovascular disease remains to be determined.