A 38 year old man has worsening vertigo and tremor

A 38 year old man has worsening vertigo and tremor. His symptoms are more pronounced in the morning. He has longstanding alcohol dependence and drinks 60 units of alcohol per week.

His abbreviated mental test score is 9/10. He has an intention tremor, horizontal nystagmus and walks with a broad-based gait.

Which is the most likely diagnosis?

  1. Acute alcohol withdrawal syndrome
  2. Benign positional vertigo
  3. Cerebellar degeneration
  4. Korsakoff syndrome
  5. Wernicke encephalopathy

C. Cerebellar degeneration


The clinical features suggest a cerebellar problem. Cerebellar degeneration is a recognised complication of prolonged excessive alcohol consumption.

See relevant sections of this NICE guideline for further information on alcohol-use disorders : https://www.nice.org.uk/Guidance/CG100