Following an infarction in the right cerebral hemisphere, massive cerebral edema developed in a woman and led to a marked intracranial hypertension and to a progressive "uncal and central herniation." The downhill course was reverted with a decompressive operation. Epidural pressure was monitored during the procedure and in the postoperative period. She showed progressive recovery from the initial motor, sensory, and visual field losses. Among 18 reported patients with cerebral infarction who underwent surgical decompression, 11 presented pupillary asymmetry, 14 were in stupor or coma, and 18 were either hemiplegic or hemiparetic preoperatively. Seven died following the operation. Among four cases of cerebellar infarction who underwent similar procedures, there were three survivors. Due to the lack of a controlled study the data available so far are not conclusive as to the beneficial effects of surgical decompression for cerebral or cerebellar infarcts. Some data of clinical relevance on cerebral edema and intracranial hypertension associated with cerebral infarction are reviewed.