Vertebrobasilar arterial insuffciency(VBI) is one of the most common causes of vertigo. Most cases of VBI have abnormal neurologic symptoms and signs, but some patients have only vertigo without other abnormal neurologic symptom or sign. In these cases, it is diffcult to differentiate VBI form peripheral vertigo. Even though the electronystagmography(ENG) gives us good information to differentiate peripheral vertigo from central vertigo, angiography should be needed for confirmative diagnosis. Recently, we experienced a case of vertebrobasliar arterial insufficiency. Forty-nine-year-old male patient complained of vertigo in the emergency room. He was referred to otolaryngologist by neurologist because he was diagnosed as peripheral vertigo through neurologic examination. We tested him with neuro-otologic examination and ENG. We noted the findings of visual fixation failure on spontaneous nystagmus test, failure of saccade on random saccade test, failure of pursuit on smooth pursuit test and reverse optokinetic nystagums on optokinetic nystagmus test. He was first dianosed as central vertigo with the ENG findings. After brain MRI and vertebral angiography, the patient could be confirmed as vertebrobasilar arterial insufficiency.