1. Concomitant symptoms In peripheral lesions, vestibular (vertigo) and cochlear (tinnitus) symptoms are parallel because the vestibular and cochlear structures are similar and easily damaged at the same time. The vestibular (vertigo) and cochlear (tinnitus) symptoms are parallel to each other. In brainstem lesions, because the vestibular and cochlear body fibers are separated in the brainstem, such patients often only have vertigo without tinnitus; if both vestibular and cochlear functions are involved, suggesting that the lesions are widespread, the clinical manifestations of other brainstem structures are often involved. 2.Nystagmus direction Vertical nystagmus often indicates brainstem lesions. The direction of horizontal nystagmus points to the side of the disease in central lesions and away from the side of the disease in peripheral lesions. However, there are exceptions, such as Meniere’s syndrome. In peripheral lesions, the nystagmus has a latency period (2 to 20s), short duration (less than 1 minute), easy fatigue (the vertigo and nystagmus are gradually reduced if the evoked position is repeatedly taken), the nystagmus is in a single direction (often rotational and dorsal to the lesion side), and the vertigo is severe and occurs in a single evoked position; in central lesions, there is no latency period, long duration (longer than 1 minute), and no easy fatigue. Central vertigo has no latency period, long duration (longer than 1 minute), no easy fatigue, the direction of nystagmus varies with different positions, vertigo is lighter, and vertigo can be induced by multiple positions. Central vertigo is often accompanied by clinical manifestations of other brainstem structures, such as the involvement of brain nerve, sensory and motor conduction bundles. Dizziness or other pseudo-vertigo is often described as a sense of swaying, light-headedness, swimming or walking in the air, feeling “out of my mind”, and falling down. Psychiatric patients characterized by anxiety attacks often experience this. It can be triggered by hyperventilation and is accompanied by panic, shortness of breath, tremor and sweating. Other symptoms of pseudovertigo are less certain and may include headache or pressure, particularly in the affected ear region. Pseudovertigo is mostly a manifestation of systemic diseases, such as severe anemia, change of position and exertion, which may lead to light-headedness, fatigue and weakness. In patients with emphysema, exertion is often accompanied by weakness and special sensation in the head; coughing may cause vertigo or even syncope due to the decrease in the amount of blood returned to the heart (cough syncope). Hypertension is often accompanied by vertigo, which may be due to anxiety, or impaired cerebral blood supply. Postural vertigo is often caused by abnormal vasomotor reflexes and impaired cerebral blood supply. It is common in the elderly, bedridden and weak people. When the patient suddenly rises from a lying or sitting position, there is shaking, blurred vision and stars in front of the eyes for a few seconds. The patient is often forced to stand still and hold on to nearby objects until the vertigo subsides or disappears. If vertigo is accompanied by loss of consciousness, syncope and epilepsy should be considered and the cause should be further investigated.