We report a case of a 72-year-old woman who developed sudden-onset right hemiplegia and global aphasia 8 days after splenectomy performed for Werlhof’s disease. Hematological tests revealed a progressive increase in platelet (PLT) count from the day of the operation to the day of ischemic stroke. Carotid duplex showed a recent left internal carotid occlusion, and transcranial Doppler showed reduction of mean left middle cerebral artery velocities in the acute phase, with subsequent improvement in velocities. This case stresses the importance of rethinking the clinical criteria for prophylactic anti-PLT treatment in elderly patients requiring splenectom