Objective: Vertigo is a common complaint in the emergency room. Vertigo can be central or peripheral in origin and it is important for an emergency physician to make a correct differential diagnosis. The purpose of our study was to emphasize the role of cranial magnetic resonance imaging (MRI) and audiological tests in differential diagnosis of patients who present with vertigo to the emergency room. Material and Methods: Fifty patients (31 female, 19 male, mean age 50.84 years) with vertigo who were admitted to the Hacettepe University Faculty of Medicine Emergency Room (ER) between 01.10.2004 and 31.01.2005 were included in the study. Physical and neurological examinations of all patients were performed by senior residents and all patients were evaluated by Ear Nose Throat specialists. Audio logic and vestibular tests and MRI with 3T (Tesla) magnetic field power were performed in all patients. Results: Among 29 patients with normal neurological examination, only 3 (10.3%) had lesions on MRI. MRI scans revealed lesions suggesting central vertigo etiology in six (18.2%) patients out of 33 with abnormal audiological test suggesting peripheral vestibulopathy. Conclusion: In conclusion, in our prospective study, urgent cranial MRI technique in patients presenting to the emergency room with vertigo may reveal significant findings regarding the differential diagnosis and concomitant pathologies. However, meticulous neurological examination can exclude central vertigo in the majority of the patients.