목적: Bilateral vestibulopathy is characterized by bilateral impairment of function in the peripheral vestibular system. However, bilateral vestibulopathy remains a diagnostic challenge because symptoms are not consistent and each diagnostic test has its own limitations, and may reveal contradicting results. We aimed to investigate the various clinical and laboratory characteristics of bilateral vestibulopathy which was diagnosed by video head impulse test (vHIT). 방법:1789 patients with dizziness underwent the vHIT in our institution from January 2012 to January 2015. Among them, 65 (3.6%) patients with bilateral positive vHIT were retrospectively analyzed. Data on demographics, various clinical features including symptoms, initial diagnosis, etiology, and laboratory test results were analyzed. 결과:65 patients with bilateral positive vHIT were divided into 3 groups, according to results of the caloric test. Group 1 had bilateral caloric weaknesses (N=15, 23.1%), Group 2 had unilateral caloric weakness (N=13, 20%) and Group 3 had normal caloric responses on both sides (N=37, 56.9%). Although unsteadiness (N=8, 53.5%) is most frequent in group 1, vertigo was more frequent in groups 2 and 3. Oscillopsia (N=3) was only presented in group 1 as a chief complaint. Among the 3 groups, group 2 (70.38 ± 11.96 years) and group 3 (69.03 ± 11.01 years) were older than group 1 (54.80 ± 21.53 years) (p<0.05, respectively). Also, group 1 (0.45 ± 0.22) recorded a lower average gain on vHIT compared to groups 2 (0.72 ± 0.17) and 3 (0.80 ± 0.14) (p<0.05, respectively). In the 41 patients who underwent the rotary chair test, 10 (100%) of 10 patients of group 1 showed decrease on gain. But only 2 (20%) of 10 in group 2 and 1 (4.7%) of 21 in group 3 revealed decrease on gain. Among the 38 patients who underwent cervical vestibular evoked myogenic potentials (cVEMP), 7 patients showed interaural asymmetric responses, 20 patients had bilateral no responses, and the remaining 11 revealed bilateral normal responses. 결론:Among the patients with bilateral positive vHIT, group 1 (bilateral caloric weakness) patients tended to show typical presentations of unsteadiness or oscillopsia, and group 2 (unilateral caloric weakness) and group 3 (both normal caloric responses) did not show typical presentation and significantly older than group 1. Although gain of vHIT was significantly decreased in group 1, group 2 and 3 showed bilateral positive catch up saccades with a relatively normal gain. In conclusion, some older patients with bilateral vestibular ocular reflex deficit in high frequency acceleration existed and it might have accounted for a part of geriatric dizziness.