Vertigo is the subjective experience of the patient's disorientation in space, with the illusion of movement of the patient himself and/or the space that surrounds him. Causes of vertigo are divided into peripheral and central. Peripheral causes of vertigo include benign paroxysmal positional vertigo, Ménière's disease, vestibular neuritis, labyrinthitis and others. Central causes of vertigo include transient ischemic attack in the vertebrobasilar arterial system, ischemic posterior circulation stroke, multiple sclerosis, epilepsy, tumors of the central nervous system, and others. Although in patients with vertigo as an urgent neurological symptom, differential diagnoses such as ischemia of the vertebrobasilar circulation and tumors of the central nervous system could be life-threatening, the majority of acute vertigo is caused by peripheral disorders such as benign paroxysmal positional vertigo. In the diagnosis of patients with acute vertigo as part of the emergency medical service, the most important thing is a comprehensive anamnestic approach and a detailed clinical examination, which in most cases are sufficient to establish a diagnosis. Accurate data on the duration, severity of vertigo symptoms, factors that caused it and accompanying symptoms, but also lifestyle habits of patients with acute vertigo are extremely important. Clinical examination and clinical tests play a significant role in diagnosis and distinguishing peripheral from central causes. The Dix-Hallpike test proved to be a test of high sensitivity and specificity in the diagnosis of patients with BPPV. The HINTS examination (head impulse test, nystagmus, test of skew) is also an indispensable tool in differentiating peripheral from central causes of vertigo. Only a small number of patients with vertigo in the emergency department require neuroradiological methods in diagnosis, mainly if a central cause is suspected or when the clinical status remains elusive. It is extremely important to determine the time frame of the onset of symptoms so that the results of neuroradiological examinations can be interpreted correctly. The treatment of vertigo as an urgent neurological symptom depends on the etiology of the disease. Central etiology often requires urgent treatment.