Room tilt illusion is a subjective distortion of verticality with transient paradoxical rotation of the visual field, usually in the frontal plane. It might result from dysfunction of the vestibular pathways with subsequent contradictory vestibular, visual, and proprioceptive inputs and erroneous cortical integration. It has already been described in association with brain stem and cortical lesions, but reports of cases of peripheral origin are scarce. We report here 23 cases of room tilt illusion, all but 2 occurring in patients with either vestibular peripheral abnormalities or normal assessment findings. A review of the literature is presented, as well as a hypothesis addressing this phenomenon.