Immune thrombocytopenia (ITP) is an autoimmune condition born of platelet destruction and impaired production typically resulting in bleeding symptoms with paradoxical risk of thrombosis. The latter is not yet fully understood. Here, we describe a pediatric patient who developed multiple cerebral sinus venous thromboses (CSVTs) while receiving romiplostim in combination with a steroid requiring simultaneous management of both ITP and significant thromboses.