The clinical presentation of cerebellar hemorrhage can range from symptoms mimicking ischemic stroke to catastrophic neurologic decline. Symptomatology largely depends on the size of the hemorrhage and the degree of perilesional edema. The posterior fossa is a tight compartment with virtually no additional space to accommodate the mass effect. Thus, the hematoma and its associated swelling can cause obstructive hydrocephalus and brainstem compression, in severe cases contributing to early mortality, but outcome can be good if surgical intervention is appropriately timed. This article summarizes the current multidisciplinary approach to cerebellar hemorrhage, and addresses the controversies regarding its optimal management.