Vertigo is the illusion of motion. One must first establish that the patient has vertigo rather than presyncope or disequilibrium. Next, one must attempt to determine whether the vertigo is central (brainstem, cerebellum) or peripheral (eighth nerve, inner and middle ear) in origin. Peripheral vertigo usually presents with nausea, vomiting, hearing loss, tinnitus, and marked, almost violent rotational symptoms, with no associated neurologic abnormalities. Nausea, vomiting, hearing loss, and tinnitus are mild or rarely present in central vertigo. Vertical nystagmus is a finding highly suggestive of brainstem disease, as are associated ocular palsies, ataxia, dysarthria, and peripheral sensory deficits.