Assume a uniform, multidimensional grid of bivariate data, where each cell of the grid has a count ci and a baseline bi. Our goal is to find spatial regions (d-dimensional rectangles) where the ci are significantly higher than expected given bi. We focus on two applications: detection of clusters of disease cases from epidemiological data (emergency department visits, over-the-counter drug sales), and discovery of regions of increased brain activity corresponding to given cognitive tasks (from fMRI data). Each of these problems can be solved using a spatial scan statistic (Kulldorff, 1997), where we compute the maximum of a likelihood ratio statistic over all spatial regions, and find the significance of this region by randomization. However, computing the scan statistic for all spatial regions is generally computationally infeasible, so we introduce a novel fast spatial scan algorithm, generalizing the 2D scan algorithm of (Neill and Moore, 2004) to arbitrary dimensions. Our new multidimensional multiresolution algorithm allows us to find spatial clusters up to 1400x faster than the naive spatial scan, without any loss of accuracy.