How do you address incidental small cerebellar infarcts seen on MRI?

I would obtain a CTA of the head and neck to look for vertebrobasilar disease. Probably too low yield to obtain an echocardiogram and Holter monitoring.

I generally do the whole stroke workup; CTA and referral to cardiology.

I handle it similarly to how I would approach a symptomatic stroke, but I tend to conduct the workup as an outpatient. The exception arises if it's an acute case (DWI positive) that seems embolic; in such instances, I opt for an expedited inpatient workup.