Cerebellar infarcts can cause serious complications due to their unique location. The posterior cranial fossa, where the cerebellum is located, is known to be a very small space with little additional room for expansion. Therefore, any injury to the cerebellum carries the risk of compression of the fourth ventricle and brainstem. One study reported that approximately 20% of patients with cerebellar infarction develop clinical and imaging worsening symptoms. Cerebellar ischemia is usually caused by embolism or large vessel atherosclerosis. Vertebrobasilar artery entrapment is another important cause of cerebellar infarction. There are three main vessels supplying the cerebellum: the posterior inferior cerebellar artery, the anterior inferior cerebellar artery, and the superior cerebellar artery. Complications such as brainstem compression or obstructive hydrocephalus caused by cerebellar infarction can be life-threatening at any time. Patients with cerebellar infarction often present with nonspecific symptoms such as dizziness, nausea, vomiting and headache. Nuclear magnetic diffusion-weighted images can show the site and size of the infarct. Antiplatelet monotherapy is generally used in the acute phase, and dual antiplatelet therapy is ineffective in massive ischemia of the cerebellum due to the risk of hemorrhagic transformation. Clopidogrel is best avoided in patients with major strokes requiring decompression surgery or ventriculostomy. In the acute phase, blood pressure, blood glucose, and lipids should be controlled to prevent electrolyte disturbances and bed-ridden complications. Surgical options should be considered when clinical deterioration occurs. Signs of deterioration include decreased level of consciousness, downward displacement of conjugate gaze (sunset eyes), decreased gaze, and cranial nerve deficits. Treatment of risk factors such as hypertension, diabetes mellitus, hyperlipidemia and obesity is important in the prevention of secondary stroke. Lifestyle changes (increased physical activity and smoking cessation) are also essential for prevention.