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TIP: The main signs can be remembered by the mnemonic DANISH

1. Dysdiadokinesia & Dysmetria (past pointing) - inability to perform and sustain a series of rapidly alternating muscle movements (typically flipping one hand rapidly in the palm of the other). The patient overshoots when attempting to reach a point with their finger

2. Ataxia - gross incoordination of muscle movements. The patient may be very unsteady on their feet towards the side of the lesion. The patient may also show rebound, where pushing down on the outstretched upper limb causes it to rebound up past its original position.

3. Nystagmus - a repetitive, involuntary oscillation of the eyes. The patient may also complain of blurred vision.

4. Intention tremor - a wide tremor during voluntary movements, such as holding out the hands.

5. Slurred speech - speech may be imprecise, slow and distorted.

6. Hypotonia - patient may have muscle weakness on the side of the lesion.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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