Diagnosing stroke among patients with vertigo is a challenge because around 50% of vestibular stroke is not accompanied by focal neurological signs. The brain CT arranged in ER is not sensitive for acute posterior fossa stroke. The associated auditory symptom is not necessarily a benign sign but implies a potential risk of AICA infarction. Stratification of stroke risk factors (i.e. ABCD2), assessment of stance and gait (i.e. Carmona's truncal ataxia), and specific oculomotor examinations (i.e. HINTS and HINTS Plus) can enhance the diagnostic accuracy and may improve clinical outcome for these "atypical" stroke patients.