Massive pulmonary embolism (PE) with concomitant intracranial hemorrhage (ICH) has a high mortality rate. Although thrombolytic therapy is generally accepted as emergent treatment for massive PE, the risk of bleeding complications are significant. A 69-year-old woman presented with acute PE 11 days after onset of ICH. Thrombolysis was deferred, and emergent surgical embolectomy with cardiopulmonary bypass (CPB) was elected. Patient outcome was favorable without recurrence of ICH.