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Sickle cell anemia (SCA) is a genetic disorder characterized by the production of abnormal hemoglobin S, leading to red blood cell sickling and subsequent vaso-occlusive events. Neurological complications, particularly strokes, significantly contribute to the morbidity and mortality associated with SCA. While ischemic strokes are more common, hemorrhagic strokes, though less frequent, present significant challenges, especially in the pediatric population. Understanding the complex interplay of genetic, environmental, and hematological factors is crucial for managing these cases. We report two cases of pediatric patients with SCA who experienced rare hemorrhagic strokes. The first case involves a nine-year-old male presenting with a subarachnoid hemorrhage, revealing cortical ischemia and multiple cerebral artery strictures. Early supportive measures resulted in a good clinical improvement, after which the patient underwent bone marrow transplantation. The second case describes a seven-year-old male who developed an epidural hematoma during a vaso-occlusive crisis, necessitating emergency surgical intervention. After initial persistent neurological deficits, the patient began to show gradual improvement with ongoing management, reflecting the complexity and severity of such events. Hemorrhagic strokes in pediatric SCA patients, though rare, represent significant clinical challenges due to their multifactorial etiology and complex management needs. These cases underscore the importance of a multidisciplinary approach and advanced diagnostic tools in managing hemorrhagic complications in SCA. Further research is essential to unravel the pathophysiological mechanisms and develop targeted prevention strategies to improve outcomes for this vulnerable population., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Research and Ethical Committee, King Salman Armed Forces Hospital issued approval KSAFH-REC-2024-593. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mustafa et al.)