Pregnancy can change the behavior of brain gliomas with increased growth rate, increased frequency of seizures, and anaplastic transformation. Very rarely the presentation may be hyperacute due to intratumoral hemorrhage. We report and discuss them a management of the hemorrhagic infarction of a newly diagnosed postcentral anaplastic astrocytoma in a pregnant woman. A first MRI discovered the glioma; two days later, after acute neurological deterioration, a second MRI showed a dramatic increase in volume with intratumoral hemorrhage, possibly caused by venous thrombosis. The patient underwent a cesarean section and an urgent craniotomy with subtotal resection and a good neurological outcome. An urgent craniotomy can be performed either during pregnancy or after a cesarean delivery if the patient is at least in the gestational age of 34-36 weeks. Not only decompressing but also resecting the tumor allows performing the first stage of oncological treatment and avoiding a second surgery. Despite a potential catastrophic onset, even this type of presentation can lead to good clinical results.