This study investigated whether vertiginous attacks indicate a high probability for posterior fossa metastasis in lung cancer patients. Twenty-five lung cancer patients having vertiginous episodes were enrolled in this study. All patients underwent a battery of audiovestibular function testing and MR imaging study. Ten (40%) of 25 lung cancer patients with vertigo were proven to have posterior fossa metastasis (PM1 group), while the other 15 patients had no posterior fossa metastasis (PM0 group). Of the PM1 group, all were adenocarcinoma with the women predominant (80%). Seven (70%) and two (13%) patients of PM1 and PM0 groups had other (bone, liver) systemic metastases before the vertigo episodes, respectively, exhibiting significant difference between them. However, no statistical differences existed in the audiovestibular function testing between the two groups. In contrast with 58% of PM0 group, none of the patients in PM1 group survived for>> 3 years after the vertiginous attacks. The mean interval from vertiginous episode to death was 16 months (range 5-27). In conclusion, vertiginous attack in a lung cancer patient having other systemic metastases indicates a high probability of posterior fossa metastasis.