Central vestibular pathways issuing from the otolith may be involved in Wallenberg syndrome, resulting in specific symptoms. These "otolith" symptoms are less well known than vestibular symptoms issuing from the canal. We report 15 patients with Wallenberg syndrome who had one or more clinical signs suggestive of otolith pathway involvement. Clinical examination looked for: Eleven patients presented ipsilesional skew deviation; ipsilesional tilt of subjective visual vertical was found in 8 patients; a room tilt illusion was described in 4 patients in either the frontal or the sagittal plane: 9 patients presented axial lateropulsion toward the lesioned side; 8 patients presented ipsilesional ocular lateropulsion, 6 of them in association with axial lateropulsion. Finally, 3 patients presented positional nystagmus evoked by head tilt in the roll or the pitch plane. Pathophysiology of these symptoms and evidence for an otolith pathway involvement are discussed.