Immune thrombocytopenia (ITP) is an immune-mediated disorder where patients are usually asymptomatic or present with minimal bruising. Although the most serious, wellrecognized complication of ITP is life-threatening bleeding, there have been recent reports of thromboembolic (TE) events associated with this condition. We report two patients with ITP who developed cerebral infarcts and raise postulates for the pathophysiology of TE events in ITP. A 56-year-old female presented in June 2009 with left-sided arm and facial weakness, and expressive dysphasia. Computerized Tomography (CT) scan and carotid Dopplers were normal although Magnetic Resonance Imaging demonstrated infarcts in her parietal and temporal lobes. She had been under haematological follow-up for ITP, which had been diagnosed 7 years previously with an initial platelet count of 5× 109/l. Although she had initially made an excellent response to steroids at the time of diagnosis, this was discontinued based on patient preference to avoid steroid-related side effects. Similar treatment was not initiated during this episode in case a sudden increase in platelet count worsened the thrombotic event. She has recovered reasonably with physiotherapy although her platelet count has remained< 10× 109/l for the last 9 months. Antiphospholipid and anticardiolipin antibody tests to identify a common cause for thrombocytopenia and thrombosis were negative. An 81-year-old female was admitted in February 2010 with light-headedness and fluctuating disturbance of consciousness. She had a history of diabetes, hypertension and ischaemic heart disease and a permanent pacemaker fitted for bradycardia. She had been investigated a week previously for thrombocytopenia (platelet count 15× 109/l), found on a routine blood count. Bone marrow examination was normal with no dysplasia or malignant features but increased number of megakaryocytes suggestive of a diagnosis of ITP. She was kept under close monitoring until the present episode when her platelet count dropped to 8× 109/l. CT scan confirmed a large frontal lobe infarct. Antiplatelet agents were discontinued and she was started on oral prednisolone (1 mg/kg/d) in addition to a platelet transfusion to prevent haemorrhagic transformation of the infarct. Her count started improving gradually and at the last follow-up, 2 months after the stroke, her platelet count is 74× 109/l on 15 mg of prednisolone. Once again, tests for anticardiolipin antibodies and antiphospholipid syndrome were negative.