Cerebrovascular disease (CVD) is the second cause of death in the world and the first in Uruguay. The malignant cerebrovascular accident (CVA) represents 5% of the cases of cerebral ischemia in our country. In these patients, the use of preoperative intracranial pressure monitoring has not shown utility. Currently, decompressive craniectomy has managed to reduce the mortality and morbidity of patients with malignant stroke. The clinical case of a patient who presented a malignant CVA is described below and a non-systematic review of the literature on the surgical treatment of them is performed.