Postoperative stroke after cardiac surgery is often a lethal complication. Herein, we report on a patient who suffered space-occupying ischemic stroke after surgical treatment of type A aortic dissection. He underwent decompressive hemicraniectomy and, despite residual hemianopsia and left side flaccid hemiplegia, survived surgery and was discharged for rehabilitation. This observation suggests that early consultation with a neurosurgeon, intracranial pressure monitoring and, when indicated, decompressive hemicraniectomy should be considered in order to reduce the high mortality rate associated with ischemic stroke after cardiac surgery.