We present a case of moyamoya vasculopathy occurring in a patient who used heroin for years. The case was presented with subarachnoid hemorrhage and infarction in left frontal lobe. Cerebral angiography revealed the typical findings of moyamoya disease, with occlusion of the supraclinoid portion of left internal carotid arteries, coupled with abnormal collateral vessels. Cerebral magnetic resonance imaging revealed left frontal lobe borderzone infarction and subarachnoid hemorrhages which were attributed to a heroin induced moyamoya vasculitis of the basal cerebral arteries. We believe that our case is worthy of particular attention because of the rarity of moyamoya disease accompanying SAH in heroin dependency.