OBJECTIVE: To report the case involving a patient who had a stroke that initially presented as vertigo of peripheral origin. This patient had a history of dyslipidemia, hypertension, and myocardial infarction. REPORT: A 45-year-old man was admitted to the emergency room with sudden vertigo, vomiting, and hypertensive crisis. On the third day of hospitalization, he complained of hearing loss in the right ear, and therefore, an ear-nose-throat (ENT) evaluation was conducted. Physical examination revealed left horizontal nystagmus, both spontaneous and semi-spontaneous, and gait ataxia. Based on the patient's medical history and physical examination results, magnetic resonance imaging (MRI) was suggested. MRI revealed acute ischemia in the right middle cerebellar peduncle. Two days later, he developed right peripheral facial paralysis. After hospitalization, the patient was put in ambulatorial accompaniment and vectoelectronystagmography was carried out, which revealed caloric areflexia and absence of EIFO right. Audiometry was also carried out and revealed moderate neurosensorial hearing loss in the right ear. The treatment proposed was vestibular rehabilitation and motor physiotherapy. The outcome was favorable despite discontinuation of treatment. CONCLUSION: Labyrinthine dysfunction due to vascular causes usually leads to decreased auditory and vestibular functions. On the anterior inferior cerebellar artery (AICA) infarction, these functions cause a wide spectrum of changes involving the middle cerebellar peduncle structures, lateral-inferior region of the bridge, cerebellar hemisphere, and the inner ear. If there is no associated neurological signal, distinguishing the central and the peripheral etiology becomes challenging. Proper evaluation of dizziness, however slight, and morbidity history is of paramount importance for diagnosis of neurological or systemic diseases, which can cause permanent defects if identified too late.