Abstract The literature on cerebellar degeneration associated with chronic alcoholism is reviewed. The clinical manifestations of this are a cerebellar syndrome characterised by instability of gait and stance, and incoordination of the lower limbs. In autopsied cases degenerative changes are found in the anterior superior vermis of the cerebellum. The clinical details of 2 cases without autopsy confirmation are presented as illustrations of the clinical problem and of the improvement which may occur with abstinence from alcohol. The neuropathological details of 7 autopsied cases are presented. The clinical features in these patients are those found in the literature, namely, a cerebellar syndrome with predominant involvement of gait and stance and relatively little affection of upper limb function or of speech. In the autopsy material changes of a degenerative and atrophic type were found in the cortex of the anterior superior vermis of the cerebellum. There were corresponding changes in the olivary nuclei of the medulla in some cases. The changes of Wernicke's encephalopathy were found in all but one case. Central pontine myelinolysis was present in one patient. The significance of this particular syndrome in relationship to atrophy of the vermis is discussed in the light of cerebellar physiology. It is concluded that chronic alcoholism may be associated with this form of cerebellar degeneration.