Introduction The Suppression Head Impulse Paradigm (SHIMP) is a valuable tool for assessing vestibulo-ocular reflex (VOR) function by eliciting anti-compensatory saccades (ACs) in individuals with intact angular VOR (aVOR). While previous studies have extensively examined VOR gain in neurological disorders, the absence of ACs in patients with preserved VOR gain has not been described. This study investigated whether the absence of ACs during SHIMP is a distinguishing feature of central vestibular dysfunction. Methods This cross-sectional study included 119 patients with multiple sclerosis (PwMS), severe traumatic brain injury (PwTBI), stroke (PwS), and Parkinson’s disease (PwPD). The video Head Impulse Test (vHIT) was performed to assess the VOR gain across all semicircular canals using both the HIMP and SHIMP paradigms. The presence, absence, or delay of ACs was systematically recorded. Results Among the 119 patients evaluated (238 semicircular canals), 24 (20%) demonstrated normal aVOR gain but failed to generate ACs during SHIMP. The absence of ACs was observed in seven PwMS, five with PwTBI, six with PwS, and six with PwPD. Conclusion The absence of ACs despite normal VOR gain suggests a potential impairment in the central pathways controlling saccadic responses, independent of peripheral vestibular function. These findings underscore the clinical relevance of integrating the SHIMP into vestibular assessments to improve the identification of central vestibular dysfunction in neurological disorders.