Peripheral vestibular disease, originating in the inner ear, is more common and often idiopathic in older dogs, earning it the nickname old dog vestibular syndrome. Onset is dramatic: the pet may fall, refuse to stand, or vomit from motion-sickness-like nausea. Most cases improve significantly within 72 hours and resolve within two to three weeks. Central vestibular disease, originating in the brain, is rarer and more serious, potentially indicating a tumor, infection, or stroke. Diagnosis may require blood tests, ear examination, and advanced imaging like MRI. Supportive care includes anti-nausea medication, assisted feeding, and preventing falls during recovery.