Physiological and clinical vestibular vertigo syndromes are commonly characterized by a combination of phenomena involving perceptual, oculomotor, postural, and vegetative manifestations: vertigo, nystagmus, ataxia, and nausea. Most of the central vestibular syndromes and some of the peripheral vestibular syndromes may have a vascular etiology. Episodic vertigo and oculomotor abnormalities are common early symptoms of reduced vertebrobasilar blood flow due to the steep pressure gradient from the aorta to the terminal pontine arteries. To date, at least eight subgroups of anterior inferior cerebellar artery (AICA) infarction have been identified according to the pattern of neurootological presentations, among which the most common is the combined loss of auditory and vestibular functions. Unilateral ischemic lesions of the pontomesencephalic vestibular pathways, which run along the medial longitudinal fasciculus (MLF), predominantly cause vestibular tone imbalance in the roll plane. Unilateral thalamic infarctions may cause contralateral falling, astasia, or contralateral ocular tilt reaction (OTR).

Ataxia is the most important sign of cerebellar disease, but there are other potential causes of ataxia. Postural and limb tremor are additional signs of cerebellar disease. Patients with cerebellar disorders may walk with a wide-based, staggering gait, making it seem as if they were intoxicated by alcohol. Frontal lobe disorders might cause cerebellar-like symptoms with walking difficulties and clumsiness. Frontal lobe lesions are commonly associated with impairment of cognitive function and changes in personality, and often cause urinary incontinence. Lesions of the cerebellar hemisphere are followed by ipsilateral limb ataxia including hypotonia in acute lesions, and if the dentate nucleus is involved, kinetic tremor. Vascular lesions of the cerebellum itself and of the corticopontocerebellar and dentatothalamic pathways might result in ataxia. Limb ataxia and ataxia of gait are common in superior cerebellar artery (SCA), the posterior inferior cerebellar artery (PICA), and the anterior inferior cerebellar artery (AICA) territory infarctions.