Spontaneous cerebellar hemorrhage is infrequently reported in children, although this disorder account for roughly 10% of nontraumatic intracranial hemorrhages in adults. We studied three cases that demonstrated the clinical features, radiological findings, pathological features, and outcome in this condition. A review of the literature uncovered 21 additional cases. The most commonly encountered cause of hemorrhage found in 62% of the cases was a vascular abnormality. Of the 24 patients, 15 underwent surgery and 14 of these survived. No patient survived without surgery. Computerized tomography has increased the diagnostic yield while decreasing diagnostic morbidity, and early surgical intervention provided dramatic improvement in many patients. The diagnosis of spontaneous cerebellar hemorrhage must always be considered in the examination of a patient with symptoms and signs suggesting an acute onset of a posterior fossa mass lesion.