A 67-year-old man with a history of diabetes suffered from ischemic stroke and was received urethral catheterization for 2 weeks. After removal of the catheter, he was troubled with a urinary tract infection due to neurogenic bladder that improved after antibiotic treatment and intermittent catheterization. He was then transferred to our hospital for convalescent rehabilitation on day 23; however, asymptomatic gross hematuria appeared 11 days later. Based on the findings of an abdominal CT, the diagnosis of emphysematous cystitis was made. He was transferred for urological treatment and improved immediately with a combination of bladder drainage and appropriate antibiotics. Emphysematous cystitis, often complicated by diabetes, occurs secondary to dysuria which is frequently observed as neurogenic bladder in post stroke patients. In the management of such cases, especially in diabetes, we should note the risk of urinary tract infection including emphysematous cystitis at any stage and take more interest in urinary symptoms after stroke.