We present four patients who suffered from recurrent vertigo crises, which in most cases lasted hours or even days. In all of them the coincident finding was the presence of vascular compression of the brainstem (mainly vertebral dolichoectasia). Given the fact that the vertigo was always episodic and in that in the two cases where a treatment with carbamazepine could be used the result was the total suppression of the crises, we propose an ictal mechanism for them. Our findings differ from previous descriptions because: 1) the crises last longer, hours or even days, and 2) the involvement of the brainstem structures was extrinsic.