Spontaneous cerebellar hematomas occupy a special place among all intracranial hemorrhages because of the risk of sudden deterioration due to either acute hydrocephalus or brain stem compression. These hematomas also have a significant incidence of delayed worsening, necessitating careful observation in conservatively treated patients. Unlike supratentorial hemorrhages, there is not much controversy that timely surgical evacuation improves survival and hence it is mandatory for the physician manning the Emergency to know the guidelines for conservative and surgical management.

Keywords: Cerebellum; External Ventricular Drain; Hydrocephalus, Hypertension; Vermis; Suboccipital Craniotomy.