A 54-year female presented with paroxysmal tinnitus and vertigo for 2 years, which have repeatedly occurred while rotating her neck, and lasted about 10 seconds. She also suffered from hearing loss in the left ear though audiometric test revealed normal hearing threshold. An anticonvulsant medication was prescribed with a diagnosis of microvascular compression syndrome on the 8th cranial nerve and audio-vestibular evaluation and MRI scan were appointed a week later. In her next visit, she reported disappearance of paroxysmal audiovestibular symptoms after medication. In the left ear, canal paresis and abnormal auditory brainstem response were examined. In MR imaging, a large meningioma in cerebello-pontine angle in vicinity to the IAC orifice was detected, that was surgically resected by a neurosurgeon. After surgical removal of the tumor, she reported continuous dizziness due to vestibular nerve injury but the paroxysmal attack of tinnitus and vertigo disappeared without anticonvulsant medication. This case suggests that imaging study is mandatory when diagnosing microvascular compression syndrome on the 8th cranial nerve.