To explore the potential etiologies and affected sites in acute unilateral peripheral vestibular dysfunction (AUPVD) by analyzing patients’basic information, vestibular function, imaging examinations, and therapeutic outcomes. Methods: Clinical data of 36 AUPVD patients admitted to our department from February to April 2022 who met the inclusion criteria were collected. Among these, 30 underwent video head impulse test (vHIT), 26 received steroid treatment, and 3 had gadolinium contrast-enhanced labyrinthine MRI. The examination results and risk factors for cerebrovascular diseases were retrospectively analyzed and compared. Results: In the 30 patients who underwent vHIT, 25 showed abnormal results; among them, 12 cases (48%) had abnormal horizontal canal vHIT while the anterior canal was normal; some patients who underwent gadolinium-enhanced labyrinthine MRI showed enhancement signals in the lesion side vestibular labyrinth, but no enhancement signals in the vestibular nerve were observed; among the 26 patients treated with steroids, 17 (65.4%) responded well, while 9 (34.6%) had poor responses. The latter group had a significantly higher average age and a higher proportion of at least one cerebrovascular disease risk factor (P<0.05). Conclusion: The etiology of AUPVD may include various mechanisms such as inflammation and ischemia; it may affect multiple sites including the vestibular nerve and vestibular labyrinth.