TBI may be complicated by direct injury to the vestibular or eighth cranial nerve (Maskell et al. 2006; Ostrowski and Bojrab 2005). Shearing forces may lead to transection, hemorrhagic, or ischemic damage to the nerve. This may occur anywhere along its course, either within the internal auditory canal or as it enters the brain stem at the cerebellar pontine angle. Injury to the vestibular nuclei in the brain stem may lead to central findings on both physical exam and diagnostic testing, such as hemorrhage on MRI or unilateral vestibular loss on ENG/VNG. Either with conservative measure or intensive vestibular rehabilitation, improvement in vertigo is usually achieved. Ultimately, however, if the vestibular nuclei on the injured side are nonfunctional, complete compensation may be impossible (Ostrowski and Bojrab 2005).