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Stroke is an uncommon sequela of Wegener's granulomatosis, resulting primarily from vasculitic infiltration of small to medium-sized vessels. We describe a young patient with Wegener's granulomatosis and basilar artery occlusion.A 26-year-old man with histopathologically confirmed Wegener's granulomatosis suffered a brain stem stroke 24 hours after open lung biopsy. Angiography revealed midbasilar artery occlusion.Patients with Wegener's granulomatosis may experience premature large cerebral vessel occlusion. Putative etiologies in our patient include vasculitis, postoperative hypercoagulability, and/or intraoperative neck positioning leading to embolization.