We analysed the clinical and radiological findings and the long-term outcome after 49 ± 34 months in 75 patients (42 men, aged 67 ± 11 years) with spontaneous cerebellar haemorrhage (SCH). At the follow-up examination, 36 patients had died. Outcome was excellent [Rankin Scale (RS) score 0 + 1] in 22 survivors, 4 patients were moderately (RS score 2 + 3) and 13 patients were severely disabled (RS score 4 + 5). Prognostic factors are haematoma volume, intubation, hydrocephalus and clinical signs of brainstem involvement. Of the 28 surgically treated patients, outcome was favourable (RS score 0–2) in 4 patients only, 6 were severely disabled (RS score 3–6) and 18 patients had died. We conclude that the long-term outcome after SCH is frequently favourable. Because patients who were surgically treated had less favourable clinical and radiological findings, a good long-term outcome was rarely present in this group.