No data are available on the occurrence of gray matter lesions (GML) in the cerebellum of pediatric multiple sclerosis (pedMS).We analyzed frequency, number and topography of GML, and their correlation with cerebellar-related disability in pedMS at clinical onset.Fifteen adolescents with pedMS (12F/3M; mean age 14.92.2, range 11-17) were studied. Neurological and cognitive evaluations were done by means of EDSS, Trail Making Test-Part B (TMT-B) and Symbol Digit Modalities Test-oral version (SDMT). Cerebellar GML were investigated with double inversion recovery (DIR) and phase-sensitive inversion recovery (PSIR) sequences obtained with a 3T-MRI scan.All patients had white matter lesions (WML) and/or GML in the cerebellum. A significantly higher GML number was observed on PSIR compared to DIR (mean 2.32.3 vs 1.11.6; median 2.0 (IQR 1.0-2.0) vs 1.0 (IQR 0.0-1.5); p=0.004). GML were observed in 14/15 (93.3%) patients and were more frequent in the posterior than in the anterior lobe (mean 1.82.2 vs 0.470.74; median 2.0 (IQR 0.5-2.0) vs 0.0 (IQR 0.0-1.0); p=0.044). No correlation was found between lesion number or topography and EDSS (r=0.12, p=0.69), TMT-B and SDMT.At clinical onset, cerebellar GML are common in pedMS, are very often asymptomatic, do not correlate with physical and cognitive disability, and more frequently affect the posterior lobe.