Background: Bilateral cerebrovascular accident (CVA) in pediatric sickle cell anemia (SCA) is an exceptionally rare neurological complication that amplifies disease burden. While unilateral ischemic stroke is a recognized manifestation of sickle cell vasculopathy, bilateral infarction is scarcely reported and often catastrophic. This case contributes novel clinical and rehabilitative insights into the multidimensional management of such presentations in a low-resource African setting. Case presentation: A nine-year-old boy of Igbo ethnicity (HbSS) presented with three days of weakness and low-grade fever. During exchange blood transfusion he developed recurrent generalized tonic seizures, loss of consciousness, and subsequent quadriparesis. Cranial computed tomography revealed a large subacute left frontal infarct and chronic right frontal, parietal, and temporal infarcts, confirming bilateral ischemic CVA. Management included resuscitation with intravenous adrenaline, hydrocortisone, and phenobarbital; maintenance anticonvulsants (carbamazepine and levetiracetam); oxygen and antibiotics; and nutritional/hematinic support. Physiotherapy began on day 19, emphasizing spasticity reduction, joint mobility, trunk control, and caregiver training. After six physiotherapy sessions the child had modest improvements resolution of ankle clonus, mild reduction in upper-limb tone, and improved joint mobility, yet remained quadriparetic at discharge. He was conscious and seizure-free for 72 hours before discharge and referred for outpatient neurorehabilitation; the caregiver demonstrated competence in the home program. Conclusion: This case highlights that early, context-sensitive rehabilitation even when limited by medical instability can preserve joint integrity, modulate tone, and empower caregivers, thereby improving quality of survival in pediatric SCA with stroke. The report documents the rare occurrence of bilateral CVA in pediatric SCA and supports integrating physiotherapy into acute multidisciplinary care.