Acute vestibular syndrome (AVS) has a high clinical incidence, and its solitary vertigo symptoms are very common in outpatient and emergency patients from Neurology Department and Ophthalmology and Otorhinolaryngology Department. The ischemia in the brain, especially which in the post-circulation artery supplying area, is the most common cause of central AVS, manifesting as solitary vertigo and other symptoms similar to those of peripheral AVS. Thus, it poses challenges on clinical diagnosis and treatment for clinicians. With the growing understanding on the pathophysiology of the vestibular system, the knowledge about AVS due to central infarction is gradually increasing. This paper reviews the progress in AVS due to central infarction, focusing on the responsible lesions of this disease and its artery supply, as well as the characteristics of nystagmus resulting from brain stem and cerebellar lesions, and bedside examination and evaluation methods such as head impulse test (HIT), so as to promote clinicians’ understanding on this disease, and improve the level of differential diagnosis.