Case Sharing: Ms. Chen is 55 years old and recently felt numbness on the right side of her face, like she had been numbed. Previously, she had gone to take a cervical spine film because of dizziness, but no abnormality was found, and the doctor told her to put my pillow lower, and the symptoms had a slight improvement. Nearly four months Ms. Chen and feel the head, neck is very difficult, has been dizziness can not be relieved. She was puzzled, in the end, what disease triggers dizziness? What kind of examination should be done? We can often see some of the dizziness of the patient, after the attack of nervousness, afraid of their own dizziness is caused by what brain lesions. But a lot of tension to run to the hospital, the doctor either let go to see orthopedics, or let go to see the ear, nose and throat. Doctors pointed out that dizziness is quite a common disease, accounting for about 30% of the total number of outpatients and hospitalized patients. Dizziness is often manifested as a sudden and objective and does not exist a self or external objects in a certain direction of rotation, floating, rolling or drifting feeling. It is a kind of locomotor hallucination caused by vestibular semicircular canal, brainstem, cerebellum and other systematic lesions, which triggers spatial orientation disorder and balance dysfunction of the human body. The following four types are common: auricular vertigo: refers to the vestibular labyrinth sensory abnormalities caused by vertigo. The main manifestations are episodic vertigo, hearing loss and tinnitus. Severe cases are often accompanied by nausea, vomiting, pallor, sweating and other vagus nerve stimulation phenomena, and nystagmus may occur. Patients often feel the object rotation or their own rotation, walking can appear skewed or tilted, seizures in the conscious mind. Cervical vertigo: mostly caused by hypertrophic osteophytes of cervical vertebrae, resulting in insufficient blood supply to the basilar artery of the brain. Vertigo attacks are often associated with head and neck rotation, the nature of which can be rotational, floating, swaying, or feeling of lower limb weakness, unsteadiness, ground movement or tilting. These manifestations may occur singly or sequentially, and many patients may experience a combination of these sensations. Some patients only have the sensation of dizziness. If the patient changes position, it is easier to induce vertigo, or make it more dramatic; emotional factors, fatigue, car, walking, etc. can also be induced, and some patients have unknown causes. Cerebellar and brainstem diseases: mostly seen in the elderly and people with hypertension, diabetes mellitus, hyperlipidemia, long-term heavy smoking, alcoholism and other people. When the symptoms of dizziness appear, we should be highly vigilant, which may be a sign of cerebrovascular disease, and in the light case, it may cause speech and limb activity disorder, and in the heavy case, it may cause coma and jeopardize the patient’s life. Plant neurosis: about 10%, manifested as dizziness, blurred vision, tinnitus, nausea, panic, insomnia, dreams and other symptoms of neurasthenia. Dizziness and lightheadedness are not really vertigo. There are headache, dizziness, insomnia, memory loss and a series of symptoms of cerebral cortical function weakening, although many complaints, but meticulous examination is not obvious positive signs of the nervous system, the onset of the characteristics of the onset of non-episodic and transient, and the fluctuation of its symptoms are often more closely related to emotional changes. What kind of examination should be checked for dizziness? Doctors pointed out that the basic systematic examination, neurological and otological examination is very important, and Dix-Hallpike examination should be routinely performed on patients with vertigo in order to quickly identify the most common causes of vertigo. In patients with peripheral vestibular lesions, attention should be paid to targeted tests such as vestibular function, while in patients with central vestibular lesions, attention should be paid to relevant imaging tests. Many studies have demonstrated that MRI, audiometry, and vestibular function tests do not differ significantly between unselected patients with dizziness and age-matched normals, with less than 1% of tests being positive, and therefore various ancillary tests are not recommended for unselected patients with dizziness. The root cause of many misdiagnoses stems precisely from the physician’s failure to take a good history and perform the necessary clinical examination, too little knowledge of the various diseases that require differential diagnosis, and over-reliance on ancillary tests (e.g., CT/MRI of the head or cervical spine, TCD, etc.) without recognizing their limitations.