Mycoplasma pneumoniae (MP) is one of the most common respiratory pathogens causing respiratory infection in children, especially in those above 5 years old. Although rare, cerebral infarction is the most severe neurological complication of MP infection and could be fatal. Herein, we report a case of extensive and progressive acute cerebral infarction associated with MP infection, which not only received medical treatment but also underwent a decompressive craniectomy. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) revealed occlusion of the left internal carotid artery, left anterior cerebral artery, and middle cerebral artery. In order to better understand the relationships between MP infection and cerebral infarction both on clinical and radiological perspectives, literature of cerebral infarction associated with MP infection were searched and reviewed.