Objective To explore the etiology, treatment, prevention and prognosis of acute cerebral ischemic stroke after cranial cerebral operation. Methods Five cases with acute cerebral ischemic stroke after cranial cerebral operation between May 2016 and January 2017 were retrospectively analyzed. Pre-operation condition, image materials, operational process, chemotherapy, situation of ischemic stroke and prognosis was analyzed. Two cases received operation because of traumatic brain injury (TBI). Three cases received operation because of hypertensive intra-cerebral hemorrhage (ICH), among whom 1 case was diagnosed as acute occipital infarction by CT examination 6 d after operation of basilar massive hemorrhage complicalted with brain hernia, and 1 case was diagnosed as acute occipital infarction by CT examination 8 d after sudden unconsciousness and operation of thalamus hemorrhage complicated with jammed both lateral ventricles. All of the cases were misdiagnosed and mistreated. Results One case showed persisted vegetable state, and 4 cases were dead. Conclusions Acute cerebral ischemic stroke after cranial cerebral operation can be easily misdiagnosed and mistreated.Once it starts, and the prognosis is bad,meanwhile the timely prevention of it is vital.