The authors report a case of subarachnoid hemorrhage in an 18-year old man who had recently ingested one tablet of ecstasy. The patient experienced severe occipital headache 5 h after consuming the tablet. He had convulsions after onset of headache (time from onset of headache to convulsions not described). Cerebral computed tomography (CT) scans detected right-sided subarachnoid hemorrhage and blood within the fourth ventricle. Cerebral angiography detected right-sided middle cerebral artery aneurysm of 1 cm diameter. Level of MDMA in blood or urine was not reported. The aneurysm was treated surgically with aneurysm clippers. The patient recovered from surgery with transient left-sided hemiplegia (paralysis affecting one side of the body) that recovered after 4 days. The patient was discharged three weeks after admission. The authors report that this is only the second subarachnoid hemorrhage after ecstasy use described in the literature, but go observe that amphetamine or cocaine use are known to precipitate intracerebral, subdural or subarachnoid hemorrhages in humans, either through increasing hypertension or through direct actions on the vascular system. However, the authors also express their belief that intracranial hemorrhage after stimulants or ecstasy is almost always related to a pre-existing vascular malformation.