Vertigo is a subjective sensory disorder caused by multiple systemic pathologies. Patients feel a sensation of rotation or shaking in themselves or their surroundings, often accompanied by nausea, vomiting, pallor, cold sweats, nystagmus, unsteadiness, and a drop in blood pressure and slow heart rate. It is usually caused by the balance triad (visual perceptual system, proprioceptive system and vestibular system) or its cortical centers or systemic diseases affecting these cortical centers. There are too many patients with clinical dizziness, almost 1/2 of the patients in neurology outpatient clinics, but not too many patients with typical vertigo. When patients with vertigo are encountered clinically, the following diseases are usually thought of: 1. Benign episodic positional vertigo (commonly known as otoliths): typical symptoms are paroxysmal vertigo with nystagmus caused by rapid head movement to a certain position, most patients appear when sitting up, lying down, turning over, leaning forward or leaning back, and vertigo episodes last briefly, usually from a few seconds to 1 min. repeatedly induced head position vertigo can occur repeatedly, but There is no hearing loss or vestibular dysfunction, and occasional tinnitus. The Dix-Hallpike positional test is useful for diagnosis. 2. Meniere’s disease: It occurs between 30 and 50 years of age, with typical clinical manifestations of episodic vertigo, nausea and vomiting, tinnitus and deafness, and nystagmus. The vertigo is often sudden, mostly rotational, and the tinnitus often worsens before the attack, and the attack is accompanied by transient horizontal nystagmus, and in severe cases, it is accompanied by nausea, vomiting, pallor, sweating and other vagus nerve irritation symptoms. The attacks last for several minutes, hours or days, with intervals of varying length. Each episode causes further hearing loss, and the number of episodes decreases as deafness increases. When the deafness is complete, the vagus function is lost and the vertigo attacks are terminated. 3. Vestibular neuronitis: It often occurs within a few days after upper respiratory tract infection and may be related to viral attack on vestibular neurons. Clinical features include acute onset of vertigo, nausea, vomiting, nystagmus (spontaneous horizontal nystagmus) and postural imbalance. Hot and cold tests show hypoacusis on one side of the vestibule but no hearing impairment. Vertigo often lasts for days or weeks, then gradually returns to normal and rarely recurs. 4. Posterior circulation ischemia: It occurs mostly in elderly patients and patients with risk factors such as hypertension, diabetes mellitus and hyperlipidemia, with sudden onset of vertigo related to head position, which lasts for a short time and often reduces or disappears after a few minutes. The onset of the disease is often accompanied by nausea, vomiting, unsteadiness, ataxia, and positive neurological symptoms and signs, such as visual impairment, ataxia, headache, impaired consciousness, and pathological signs. 5.Phytogenic neurological disorders: Patients have significant phytogenic symptoms: nausea, vomiting, excessive sweating, palpitations, excessive dreaming, insomnia, and sometimes binaural tinnitus. No positive signs are found in the neurological examination, and the symptoms are induced or aggravated with mental tension and overwork. Personally, I think the vertigo caused by the above diseases is mostly non-specific, and the vertigo symptoms can disappear after giving symptomatic treatment such as anti-dizziness clinically, and there is no effective auxiliary examination to confirm the diagnosis.