Clinical exam · Nervous system
Cerebellar syndrome !
- Syndrome
Clumsy coordination: staggering gait, tremor when aiming, broken-up speech and abnormal eye movements.
Updated 2026-11-01
See it in 3D: Cerebellum · Vermis · Cerebellar peduncles · Fourth ventricle
What it is
The cerebellar syndrome is the set of signs that appears when the coordination provided by the cerebellum fails: ataxia, dysmetria, intention tremor, dysdiadochokinesia, nystagmus, dysarthria and hypotonia, without true weakness. Each cerebellar hemisphere coordinates the limbs on the same side and the vermis controls the trunk and gait, so the pattern of signs shows where the lesion is.
Key findings
- Scanning speech: separated, irregular syllables with varying loudness.
- Nystagmus with the fast phase towards the side of the lesion.
- Weakness and sensory loss are not part of the cerebellar syndrome itself.
Pathophysiology
- The cerebellum compares the planned movement with the one being made and corrects it; without it, movement breaks up and overshoots or falls short.
- Lateral hemispheres: limbs on the same side; vermis: trunk and gait; flocculonodular lobe: balance and eyes.
- Its pathways cross twice (towards the thalamus and then in the cord), which is why signs are on the same side as the lesion.
Common causes
- Toxic: alcohol, excess sedatives and antiseizure drugs, lithium.
- Vascular: cerebellar infarction or haemorrhage.
- Demyelinating: multiple sclerosis.
- Nutritional: Wernicke encephalopathy from thiamine deficiency.
- Posterior fossa tumours (medulloblastoma in children), hereditary (Friedreich ataxia, spinocerebellar ataxias) and paraneoplastic causes.
Tests that confirm it
- MRI shows the posterior fossa better than CT.
- Drug levels and vitamin and thyroid tests as suspicion directs.
Test yourself
Think of the answer, then tap the question to see it.
On which side of the body do the signs of a cerebellar hemisphere lesion appear?
On the same side as the lesion.
Which signs make up the cerebellar syndrome?
Ataxia, dysmetria, intention tremor, dysdiadochokinesia, nystagmus, scanning speech and hypotonia, without true weakness.
Why is a large cerebellar infarct an emergency?
Swelling can compress the brainstem and the fourth ventricle, causing hydrocephalus and a rapid fall in consciousness.
See it in 3D
The structures of Durgical's 3D anatomy where it is found.
Related
- Cerebellar tests: finger–nose, heel–shin and rapid alternating movements
- Abnormal gaits: hemiparetic, parkinsonian, ataxic, steppage, waddling
- Romberg test
- Parkinsonian syndrome
Related conditions
- Multiple sclerosis
- Alcohol use disorder
- Wernicke encephalopathy (thiamine deficiency)
- Ischaemic stroke
- Ataxia-telangiectasia
Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.
Sources: Cerebellar Disorders (MSD Manual Professional Edition, 2024); 16.5 The Coordination and Gait Exams (OpenStax, Anatomy and Physiology 2e, 2022); How To Assess Gait, Stance, and Coordination (MSD Manual Professional Edition, 2024).
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Representative model, for educational purposes only.