Background The association of visual neglect with survival after right hemisphere (RH) stroke has received only limited attention. Objective This study explores the relationship of visual neglect and its spontaneous recovery to survival in a homogenous patient group with first-ever RH stroke. Methods Fifty-one RH stroke patients who suffered an infarct between 1994 and 1997 were retrospectively followed for survival until August 31, 2009. Acute-phase neurological, neuropsychological and neuroradiological data were studied to identify predictors of survival. Results Twenty-eight patients died during the follow-up. Age, education, and poor recovery of visual neglect emerged as significant single predictors of death. The best set of predictors for poor survival in the multivariate model was poor recovery of visual neglect and low education. Conclusions Poor recovery of visual neglect is associated with long-term mortality in RH infarct patients. The follow-up of RH patients’ neuropsychological performance gives additional information about the prognosis.