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Patients with polycythemia vera are at high risk for vaso-occlusive events including cerebral ischemia and hemorrhage. Cerebral ischemic events are due to increased blood viscosity and platelet activation within the central nervous system arterial vessels. We present a case of a 65-year-old woman who presented to the emergency department with seizures followed by left-sided weakness. Hematologic investigations revealed a hyperviscous state, and magnetic resonance imaging (MRI) was consistent with bilateral hemorrhagic infarction. Genetic studies were positive for polycythemia vera mutation. Symptoms improved with phlebotomy and antiplatelet agents. Through this case, we aim to highlight polycythemia vera as a cause of hemorrhagic stroke and the importance of blood counts in the routine evaluation of the same., Competing Interests: Conflict of interest None declared., (Association for Helping Neurosurgical Sick People. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.).)