The article is devoted to the problems of differential diagnosis of central and peripheral vestibular dysfunctions. Authors discuss the case of the so-called “pseudo-acute peripheral vestibulopathy” described in literature sources. The authors observe peripheral vestibular symptoms (horizontal–torsional contralesional spontaneous nystagmus and harmonic nature of axial lateropulsion during the study of equilibrium) in a patient with central vestibular disorder genesis – demyelinating disease in the region of the vestibular nuclei in the brain stem, confirmed by magnetic resonance imaging. The data of vestibular testing and the results of spontaneous nystagmus study by means of video-oculography are analyzed. The authors bring up the issue of the necessity of more careful exclusion of lesions in the area of the vestibular nuclei of the brain stem in patients with the signs of peripheral vestibular dysfunction, especially when they are accompanied by the central vestibular symptomatology.