Introduction: Cerebral cavernous malformations (CCM) are low-flow vascular malformations. CCMs exhibit varying clinical presentations, and when accompanied by profound thrombocytopenia, they raise critical diagnostic considerations, particularly in resource-limited settings. Coexistence of CCM and Idiopathic Thrombocytopenia (ITP) is exceedingly rare, with only one pediatric case previously reported. Case Description: A 48-year-old female with a history of hypertension and hyperlipidemia presented to a community clinic in Ghana with two weeks of malaise and one week of left arm weakness. Non-contrast CT head report from outside facility noted an acute hemorrhagic lesion with vasogenic edema in the right frontal lobe, and she was referred to our tertiary facility in Kumasi. On arrival, the patient was hypertensive (173/95 mmHg) but otherwise stable with a GCS of 15. Sensation was intact, and strength was 3/5 in the left upper extremity. A CT head with contrast was performed, showing a non-enhancing, hyperdense lesion in the right frontal lobe, raising concerns for a vascular malformation. Blood pressure was promptly managed with antihypertensives and remained controlled. Initial CBC showed a WBC of 6.27 × 10⁹/L, hemoglobin of 11.2 g/dL, and a critically low platelet count of 4 × 10⁹/L. A repeat platelet count returned a value of 1 × 10⁹/L. Initially, no petechiae, purpura, or mucosal bleeding were noted, but she later developed post-menopausal vaginal bleeding and bloody diarrhea. Blood smear showed a marked reduction in platelets without schistocytes, spherocytes, or blasts. Following confirmation of profound thrombocytopenia, IV tranexamic acid and IV dexamethasone were initiated. The patient exhibited a robust response, with her platelet count rising to 32 × 10⁹/L after three days and to 91 × 10⁹/L after a week of therapy. Viral serologies (HIV, HCV, and HBV), LA, and ANA were negative. A contrast-enhanced MRI two weeks into admission confirmed a right frontal cavernous malformation with heterogeneous signal and the characteristic ‘popcorn’ appearance with blooming artifact. After stabilization and no progression of neurological symptoms, she was discharged with outpatient follow-up. Discussion: CCMs are seen in about 0.17-0.9% of the population, with an annual hemorrhage rate of 0.6-11%. While many remain asymptomatic, symptomatic lesions typically present with seizures, headaches, or focal deficits and are prone to microhemorrhage. Hemorrhage risk can be further magnified by coagulopathies, making profound thrombocytopenia a concerning comorbidity. This case illustrates the diagnostic and management challenges of ITP coexisting with a CCM. Even with platelet counts as low as 1 × 10⁹/L and mucosal bleeding elsewhere, the CCM produced a small hemorrhage with edema rather than a catastrophic bleed. Steroid responsiveness supported immune-mediated thrombocytopenia, underscoring the value of smear confirmation and treatment response. The case also underscores that platelet count alone does not predict outcome and that careful diagnostic reasoning, even in a resource-limited West African setting, can guide effective management in the United States.