cVEMP and oVEMP provide valuable information regarding the location and nature of the lesion(s) affecting central vestibular pathways because the vestibulo-collic and vestibulo-ocular reflex pathways diverge beyond the nerve root entry zone [4, 28]. Using oVEMP and cVEMP together allows for the evaluation of both ascending and descending vestibular pathways, resulting in the identification of a higher percentage of abnormalities [4, 28–30]. Patients who have brainstem involvement in multiple sclerosis or internuclear ophthalmoplegia show higher abnormality rates in oVEMP than in cVEMP [29, 31]. Additionally, oVEMP is more sensitive than cVEMP for detecting silent brainstem lesions in multiple sclerosis patients and vestibular dysfunction in VM patients [14, 29]. Furthermore, because oVEMP latencies are dependent primarily on afferent and efferent reflex limbs and central transmission, prolonged latencies are likely due to the degradation of central vestibular processing of otolith signals rather than a decline in peripheral vestibular function [26]. VEMP amplitudes can be used as independent quantitative measures of otolith function [4]. Thus, peripheral vestibular disorders frequently involve an absence of oVEMPs or decreased amplitudes, whereas prolonged latencies may indicate central vestibular lesions [32]. Significantly prolonged oVEMP latencies in our study suggest an underlying functional abnormality in the central vestibular system.