Vertigo is a relatively uncommon pediatric complaint, with correct diagnosis made even more challenging by the patient's inherent difficulty in describing his or her symptoms. Confusion may exist among vertigo, dizziness, dysequilibrium, ataxia, pre-syncope or syncope, and seizure activity by both the pediatric patient and his or her family. A complete history and physical examination, as well as appropriate ancillary studies, may assist in clarifying the diagnosis. This paper attempts, via case report and literature review, to discuss the various etiologies of acute vertigo in the pediatric population, provide diagnostic clues, and evaluate some of the available diagnostic modalities.