Pilocytic astrocytomas are relatively uncommon tumors found predominantly in the pediatric population. Reports of these tumors are extremely rare in the elderly. This is a report of a 75-year-old man presenting with two spontaneous intracranial hemorrhages and subsequent resection of a pilocytic astrocytoma. The history, evaluation, radiographic features, histopathology, rationale for surgery and potential mechanism of hemorrhage are discussed. A review of the literature summarizes the current field of knowledge of adult pilocytic astrocytomas in the setting of intracranial hemorrhage.