Left ventricular thrombosis is found in up to 30%. of cases with dilated cardiomyopathy. The main risk consists of unpredictable systemic embolization which is one of the cause of sudden death. The favorite site for lodgement of cardiac emboli is the middle cerebral artery and consequently cardiogenic cerebellar infarction without evidence of cerebral infarction is very rare. Recently we discovered a case of cerebellar infarction and large left ventricular thrombus by two-dimensional echocardiography in a 26 year old male patient who was previously diagnosed as idiopathic dilated cardiomyopathy. We treated the patient with anticoagulant therapy and found significant resolution of left ventricular thrombus by two-dimensional echocardiography about 1 month later. Therefore this case is reported along with a brief review of the literature.