Central vestibular forms of vertigo are caused by lesions along the vestibular pathways, which extend from the vestibular nuclei in the medulla oblongata to the ocular motor nuclei and integration centres in the rostral midbrain, and to the vestibulocerebellum, the thalamus, and multisensory vestibular cortex areas in the temporoparietal cortex (Brandt and Dieterich 1995). These forms of vertigo are often clearly defined clinical syndromes of various aetiologies, with typical ocular motor, perceptual and postural manifestations that permit precise (topographical) localization. The analysis of nystagmus can also be helpful for localising the lesion site (Büttner et al. 1995). This section discusses such typical findings in detail. Depending on the size of the lesion, central vestibular syndromes can occur in isolation or as part of a complex infratentorial syndrome. Additional symptoms of supranuclear or nuclear ocular motor disorders and/or other neurological brainstem deficits can also occur (e.g., Wallenberg’s syndrome with ocular tilt reaction, as well as Horner’s syndrome, sensory deficits, ataxia, dysarthria and dysphagia).