Most elderly people experience vertigo at one time or another. Vertigo is a dizziness or blackness in front of the eyes; dizziness is a feeling that the body or external objects are rotating and swaying, making it unstable to stand. The two are often seen together, so they are collectively called vertigo. What causes severe vertigo and unsteadiness in standing? There are various causes of vertigo in the elderly, including four main categories. The first category is benign paroxysmal positional vertigo. It is characterized by brief episodes of vertigo that can be induced after certain specific movements, including when raising the head, turning over, or standing upright after bending over. The etiology of benign paroxysmal positional vertigo is unknown in most cases. In addition to the known associations with head trauma, vestibular neuritis and vaginitis and complications of middle ear surgery, there is evidence that it may be associated with oxidative stress and vasculitis, and it is considered an independent risk factor for the onset of ischemic stroke. Benign paroxysmal positional vertigo is usually a self-limiting disorder that sometimes resolves on its own without receiving any treatment, but the duration of remission is long, usually around one month. The second category is posterior circulation ischemia. It refers to transient ischemic attacks of the vertebrobasilar system and cerebral infarction. The posterior circulation, also known as the vertebrobasilar system, consists of the vertebral artery, the basilar artery and the posterior cerebral artery. Structural abnormalities or diseases of the vertebrobasilar artery, such as cerebrovascular lesions like vertebral artery entrapment, vertebral artery atherosclerosis or cervical rotational vertebral artery occlusion can narrow or occlude the vertebrobasilar vessels and cause ischemia in the posterior circulation. Depending on the structures involved, posterior circulation ischemia can produce a variety of clinical manifestations such as vertigo, a sense of imbalance, and a presyncopal state. Hypertension is also a cause of vertigo in the elderly. Systolic blood pressure increases with age, while diastolic blood pressure decreases slowly and pulse pressure increases after the age of 60. When the average blood pressure rises above 180mmHg, the function of cerebrovascular autonomy to regulate the diastolic state is weakened or even disappears, while the compliance of large arteries decreases, cerebral blood vessels turn from contraction to dilation, and excessive blood flow enters brain tissue at high pressure, which can lead to dizziness and headache, nausea and vomiting, and even faint consciousness and coma. Finally, there is psychogenic vertigo, also called chronic subjective vertigo. It is an acute vertigo induced by somatic diseases that is not treated in time. The repeated occurrence of the disease puts the vestibular center or peripheral system in a state of changing instability. Thus, the primary or secondary vertigo of psychogenic origin interacts with each other and is prolonged.