Dizziness is a general, non-specific term to indicate a sense of disorientation. Vertigo is a subtype of dizziness and refers to an erroneous perception of self- or object-motion or an unpleasant distortion of static gravitational orientation that is a result of a mismatch between vestibular, visual, and somatosensory systems. Vertigo is among the most common complaints in medicine, affecting approximately 20-30% of the general population. Stroke accounts for 3-7% among all causes of vertigo. The blood perfusion to the inner ear, brainstem, and cerebellum arise from the vertebrobasilar system. Vertigo, nausea, and vomiting, along with nystagmus, represent symptoms of stroke in posterior fossa due to arterial occlusion or rupture of the vertebrobasilar system. However, the spectrum of signs and symptoms as a manifestation of stroke associated with dizziness and vertigo may be variable depending on the affected vascular territories. Stroke or transient ischemic attack should be seriously considered in patients presenting with acute vertigo in the emergency room. Differential diagnosis between vascular vertigo and other causes of vertigo can result in misclassification due to the overlapping of symptoms. Careful medical history, physical examination, neuroimaging and ear, nose, and throat studies may help to distinguish vascular vertigo from other causes.