BACKGROUND: Dizziness due to brain lesions manifests mainly in infratentorial lesions, with few cases related to supratentorial lesions having been reported. This study aimed to elucidate the clinical characteristics and demographic factors of patients with dizziness caused by cerebral infarction and to determine the site of the brain where supratentorial lesions are most prevalent. METHODS: Patients with prominent dizziness who visited the emergency room of Gachon University Gil Hospital between July 2006 and July 2007 were included. Among them, 101 patients with acute cerebral infarction were categorized into supratentorial (n=51) and infratentorial (n=50) groups based on brain MRI. Demographics and clinical characteristics of dizziness in each group were compared, and common brain sites of the supratentorial group were assessed. RESULTS: The nature of the dizziness differed between the supratentorial group (vertigo, 27.4%; presyncope, 5.9%; disequilibrium, 29.4%; ocular, 11.8%; and nonspecific, 25.5%) and the infratentorial group (vertigo, 50.0%; presyncope, 6.0%; disequilibrium, 32.0%; ocular, 0%; and nonspecific, 12.0%; p=0.02). The duration of dizziness was shorter in the supratentorial than the infratentorial group (p<0.01). In the supratentorial group, common sites of the lesion were the thalamus (19.6%) and frontoparietal lobe (15.7%). The lesion usually appeared in the left hemisphere (60.8%). CONCLUSIONS: Dizziness from supratentorial lesions manifests in different ways, and its duration is shorter than that from infratentorial lesions. The central vestibular pathway may be located in the thalamus and frontoparietal lobe.