We review studies of endoplasmic reticulum (ER) stress and the unfolded protein response (UPR) following cerebral ischemia and reperfusion (I/R). The UPR is a cell stress program activated when misfolded proteins accumulate in the ER lumen. UPR activation causes: (i) a PERK-mediated phosphorylation of eIF2a, inhibiting protein synthesis to prevent further accumulation of unfolded proteins in the ER and (ii) upregulation of genes coding for ER-resident enzymes and chaperones and others, via eIF2a(p), and ATF6 and IRE1 activation. UPR-induced transcription increases capacity of the ER to process misfolded proteins. If ER stress and the UPR are prolonged, apoptosis ensues. Multiple forms of ER stress have been observed following brain I/R. The UPR following brain I/R is not isomorphic between in vivo I/R models and in vitro cell culture systems with pharmacological UPR induction. Although PERK and IRE1 are activated in the initial hours of reperfusion, total PERK decreases, ATF6 is not activated, and there is delayed appearance of UPR-induced mRNAs. Thus, multiple damage mechanisms associated with brain I/R alter UPR expression and contribute to a pro-apoptotic phenotype in neurons. Insights resulting from these studies will be important for the development of therapies to halt neuronal death following brain I/R. It has been known for three decades that protein synthesis inhibition (PSI) occurs in brain neurons during reperfusion following global and focal ischemia (Hossmann 1993). The first identified molecular mechanisms of PSI were traced to signaling modifications in the eukaryotic initiation factors (eIF) that control global rates of protein synthesis: eIF2 and eIF4 (DeGracia et al. 2002). This raised the question as to how cerebral ischemia and reperfusion (I/R) lead to signaling modifications in the translational machinery of the neuron. An independent line of investigation revealed that depletion of endoplasmic reticulum (ER) Ca 2+ stores, a form of ER stress, caused PSI (Brostrom and Brostrom 1998). This observation was brought to bear on PSI following brain I/R, with the suggestion that ER stress is one of the cellular pathologies induced by ischemia (Paschen 1996). Subsequently, a set of interlinked molecular pathways activated in response to ER stress have been described, and collectively these pathways are referred to as the unfolded protein response (UPR; Kaufman 1999). The purpose of the present review is to critically evaluate studies showing that ER stress and UPR activation occur following brain I/R. A major result of these studies is that expression of the UPR is not isomorphic between in vivo I/R models and in vitro cell culture systems where the UPR is pharmacologically induced. Although PERK and IRE1 are activated during initial reperfusion, total PERK levels decrease, ATF6 is not activated, and there is a delay in appearance of UPR-induced mRNAs following brain I/R. These observations indicate that