The authors report a case of an otherwise healthy 33-year-old man who presented with intracerebral hemorrhage in the right frontal lobe following chronic methamphetamine use. An autopsy was performed within 2 days after death. The postmortem examination revealed cerebral edema and intracerebral and intraventricular hemorrhage. Microscopic examination revealed endovasculitis in the systemic vessels including the aorta and carotid and coronary arteries, but no aneurysm or arterio-venous malformation. Acute toxicity and chronic methamphetamine use was verified using blood and segmental hair analysis, respectively. Cerebrovascular accidents including stroke and intracerebral and subarachnoid hemorrhage are rare in young persons, but methamphetamine use is a risk factor for cerebrovascular accidents in young adults. Therefore, forensic pathologists should be aware of the acute and chronic harmful effects of methamphetamine. Detailed history taking and toxic screening tests for illicit drug use, especially methamphetamine, as well as a meticulous postmortem examination should be conducted in young patients who died due to cerebrovascular accident.