The authors reviewed 42 consecutive cases of decompressive hemicraniectomy after hemispheric ischemic stroke to assess predictors of outcome. On univariate analysis, advanced age and history of hypertension were significantly associated with unfavorable outcome, whereas thrombolysis was protective. Side of infarction, pupillary nonreactivity, degree of preoperative midline shift, and timing of surgery did not predict outcome. On multivariate analysis, older age independently predicted poor recovery (odds ratio 2.9 per 10-year increase in age).