Vertigo is a common condition sought in internal medicine outpatient clinics and emergency departments. The main diagnostic directions are summarized below. 1. Cerebrovascular vertigo can be caused by both hemorrhagic and ischemic vertigo, but the latter is more common and usually has a more acute onset. The vestibular system is mainly supplied by the vertebral artery system, and the original blood supply arteries of the inner ear and vestibular nucleus are terminal arteries. The vestibular nucleus is the largest nerve nucleus in the brainstem and is superficially located, which makes it sensitive to hypoxia and prone to symptoms. 2. Inner ear vertigo is one of the most common causes of vertigo, and its cause is unknown. Its typical symptoms are sudden and severe rotational vertigo, accompanied by tinnitus, fluctuating or progressive hearing loss or deafness. 3.Intracranial tumor vertigo Vertigo can occur from tumors in the pontocerebellar horn, brainstem, cerebellum, fourth ventricle and cerebral hemispheres. It can be caused by direct invasion or compression of the vestibular system by the tumor, or by high cranial pressure, which causes congestion and swelling of the vestibular nucleus at the base of the fourth ventricle. 4. Inner ear drug-induced vertigo Some drugs can cause toxic damage to the eighth pair of cranial nerves, mostly involving the cochlea and vestibular nerve at the same time. 5.Vestibular neuronitis The cause is still unknown, but it may be a viral infection. 6.Infectious diseases of the brain or infectious vertigo. Labyrinthitis, pontocerebellar arachnoiditis, cerebellar abscess, etc. can cause vertigo; there is a history of infectious fever and acute or subacute onset. The common infectious diseases of the brain that cause vertigo are: 7. Fourth ventricle cysticercosis may have episodic vertigo, cysticercus is either parasitic in the ventricular wall or floating in the cerebrospinal fluid, which may cause vertigo, nausea and vomiting due to the sudden change of head position that stimulates the vestibular and vagus nerves, which may have forced head position, unstable gait, and individual may have sudden fall, sudden respiratory arrest and death, as Brun’s sign attack, intermittent Normal. 8, multiple sclerosis caused by demyelinating lesions of the auditory and vestibular nerves in the brainstem. Mainly manifest vertigo, nystagmus, hearing impairment and balance disorder. Dizziness is an important symptom of multiple sclerosis, or even the first symptom. 9. cavitation of the medulla oblongata Damage to the nucleus of the vestibular nerve can cause vertigo, but to a lesser extent. The course of the disease progresses slowly. 10.Benign episodic positional vertigo It is called inner ear otolithosis. The age of onset is 30-60 years, and it is more common in the elderly. The inner ear stone is displaced by gravity due to the change of head position and irritates the vestibular nerve endings, causing vertigo and nystagmus.