The most common locations for cerebellar infarcts are the posterior inferior cerebellar artery (PICA) and superior cerebellar artery (SCA) territories and they are about equally involved. Cerebellar infarcts are often characterized by associated non-specific symptoms, transposing into clinical conditions difficult to diagnose. The clinical presentation of ischemia in the territories of the various cerebellar arteries depends on whether the ischemia affects only the cerebellum, only the brainstem, or a combination of brainstem and cerebellum. The most common symptoms are vertigo or dizziness, vomiting, abnormal gait, headache, and dysarthria. The SCA infarcts often provoke edema with brainstem compression and herniation of the cerebellar tonsils. Cerebellovestibular signs are prominent in patients with partial occlusion of the SCA territory. Dysarthria is a characteristic symptom of SCA territory infarction. Pseudotumoral infarcts are responsible for the development of increased pressure within the posterior fossa and intracranially and may mimick posterior fossa tumors.

The advent of neuroimaging has allowed clinicians to improve clinico-anatomical correlations in stroke patients. Arterial trunks supplying the brainstem include: the vertebral artery, basilar artery, anterior and posterior spinal arteries, posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery, posterior cerebral artery, and anterior choroidal artery. The arterial supply of the medulla oblongata comes from the vertebral arteries that form the middle rami of the lateral medullary fossa, the posterior inferior cerebellar artery that gives rise to the inferior rami of the lateral medullary fossa, and the anterior and posterior spinal arteries. Different arterial trunks supply blood to the pons, including the vertebral arteries, anterior inferior cerebellar artery, superior cerebellar artery, and basilar artery. The leptomeningeal arteries consist of the terminal branches of the anterior, middle, and posterior cerebral arteries forming an anastomotic network on the surface of the hemispheres.

Ataxia is the most important sign of cerebellar disease, but there are other potential causes of ataxia. Postural and limb tremor are additional signs of cerebellar disease. Patients with cerebellar disorders may walk with a wide-based, staggering gait, making it seem as if they were intoxicated by alcohol. Frontal lobe disorders might cause cerebellar-like symptoms with walking difficulties and clumsiness. Frontal lobe lesions are commonly associated with impairment of cognitive function and changes in personality, and often cause urinary incontinence. Lesions of the cerebellar hemisphere are followed by ipsilateral limb ataxia including hypotonia in acute lesions, and if the dentate nucleus is involved, kinetic tremor. Vascular lesions of the cerebellum itself and of the corticopontocerebellar and dentatothalamic pathways might result in ataxia. Limb ataxia and ataxia of gait are common in superior cerebellar artery (SCA), the posterior inferior cerebellar artery (PICA), and the anterior inferior cerebellar artery (AICA) territory infarctions.