Isolated vertigo is usually caused by perivestibular lesions. Vertigo caused by posterior circulation ischemia is usually accompanied by other local symptoms and signs. However, with the development of neurootology and neuroimaging, more and more isolated central vertigoes caused by cerebellar and brainstem infarction have been diagnosed. About 11% of the patients with isolated cerebellar infarction present with isolated vertigo, nystagmus and postural instability. Positive results of head impulse test (HIT) can distinguish acute isolated vertigo related to cerebellar stroke from benign diseases involving inner ear. Acute vestibular hearing loss may indicate the infarct in the anterior inferior cerebellar artery region. Bedside examinations including head impulse test, nystagmus and test of skew (HINTS) are superior to magnetic resonance imaging. In this paper, the diagnosis of acute isolated vertigo syndrome complicated by brainstem and posterior cerebellar circulation stroke is reviewed.