As a neurologist who spends a lot of time in the emergency room, dizziness is definitely a topic that cannot be avoided. About half of the patients come in with complaints of dizziness. There is a joke among doctors that if they see too many dizzy patients, the doctor will also get dizzy; if they see too many headache patients, the doctor will also get headache. On the one hand, dizziness is a very common symptom, with about 1.8% of young people experiencing dizziness and about 30% of older people experiencing dizziness. I’m sure you’ve heard people around you talk about the symptoms of dizziness. On the other hand, although they are all referred to as dizziness, the symptoms are actually diverse, with the following main categories: vertigo (vertigo), presyncope (dizziness, weakness, presyncope, faint), balance disturbance (unsteadiness in standing or walking), ill-defined light-headedness (often related to anxiety) that is difficult to clearly describe, and even sometimes patients experience dizziness as a symptom of dizziness. (often related to anxiety), and even sometimes patients use dizziness to refer to blurred vision or seizures. Therefore, when faced with dizziness, it is important to first distinguish which type of dizziness is present before making a definitive diagnosis. Vertigo is the most common symptom of dizziness and is the focus of this article. According to a German survey, about 7.8% of people will experience vertigo at least once in their lifetime. Stereotypically, vertigo is a subjective symptom in which the patient feels that he or she or the surrounding objects are spinning, floating, shaking or tumbling, etc. It is a motion hallucination or motion illusion. However, in practice, there are many different forms of manifestation, the most classic one being spinning, also known as visual rotation, and sometimes feeling that one is bouncing up and down like a boat, or involuntarily swaying back and forth, sometimes feeling that one’s body is involuntarily tilted to one side when standing or walking, and sometimes feeling a tendency to move in a certain direction when lying in bed. In some cases, the vertigo attacks are simply when the patient is lying in bed with his eyes closed, and when he moves, he feels uncomfortable. If vertigo is so common, what is it all about? The human body uses several sensory systems to obtain the necessary information to maintain posture and body balance. It is because these systems work together seamlessly that we can stand and walk, lie down, sit up and move freely. Once these systems are out of order, the kinesthetic illusion (hallucination) described above will occur. The information from the three systems comes from: vision, position receptors located in the inner ear, and proprioception from muscle and joint receptors. The most important of these is the position sense transmitted by the position sense receptors located in the inner ear (Figure 2), which transmit information through the vestibular nerve to the brainstem and further to the cerebral cortex and cerebellum. Therefore, problems with the position receptors in the inner ear, the vestibular nerve, the brainstem, the cerebellum, and the cerebral cortex, which is responsible for position perception, can all cause vertigo symptoms. The common diseases affecting these areas causing vertigo are the following: benign paroxysmal positional vertigo, Meniere’s disease, vestibular neuronitis, phobicpostural vertigo, basilar artery migraine, and vertigo symptoms may also occur when transient ischemic attacks and cerebral infarction and cerebral hemorrhage involve the relevant tissues of the brainstem and cerebellum, but they are often accompanied by numbness and weakness of the limbs, crookedness of the mouth and other manifestations of nerve nuclei or fiber involvement. Patients with vertigo symptoms alone as the only manifestation have about 2.7% probability of transient ischemic attack or cerebral infarction, which is a very rare condition. Therefore, if a patient presents with vertigo alone without any obvious numbness, weakness, or unfavorable movement of the limbs, facial numbness, or other neurological involvement such as distortion of the corners of the mouth or double vision, only a small percentage of patients have cerebrovascular disease. There are so many diseases that cause vertigo, but this time we will only introduce the most common one: benign paroxysmal positional vertigo. This is the first major gang in the vertigo jungle. Sometimes there is a clear cause, such as head trauma, and sometimes no clear cause can be found. Isn’t this name a bit long and roundabout? It also has a common name: otolithiasis. In the picture above, the thing that looks like a snail is the cochlea, which is responsible for perceiving sound. The snail’s tail, which is responsible for perceiving balance, and especially the three semi-annular organs that are continuous together are the semicircular canals. The calcium carbonate particles from the elliptical sac near it fall into these curved tubes (semicircular canals) and cause vertigo when the head position changes, hence the name otoliths. In particular, the posterior semicircular canal is the one with the lowest position, and its lower outlet is blocked by the ridge of the potbelly, so that the otolith does not easily slip out of the upper outlet under the effect of gravity, and it oscillates repeatedly inside this canal with the movement of the head to cause vertigo. Because of its structural peculiarities, otoliths are caused by posterior hemianopsia in about 90% of cases. The typical clinical manifestations of otoliths are vertigo with the change of head position, but when the head position remains unchanged, the vertigo symptoms may disappear quickly, usually within one minute, accompanied by nausea and vomiting, and nystagmus (when the patient’s eyes are carefully observed during vertigo, involuntary oscillations of the eyeballs can be seen), both of which are caused by the nucleus of the nerve responsible for position perception and the nucleus of the nerve responsible for gastrointestinal movement and eye movement. These two accompanying symptoms and signs are due to the presence of nerve fiber connections between the nucleus responsible for position awareness and the nucleus responsible for gastrointestinal movements and eye movements. For example, in some cases, when a typical patient wakes up from a nap, he suddenly feels a spinning sensation, accompanied by nausea and vomiting, so he lies down and stays still. After a short while, the vertigo symptoms pass, and when they take a breather and turn over, the vertigo starts again. Doctors can use the evoked test to test which semicircular canal is the problem. This provocation test is called the Dix-Hallpike test. Therefore, if the doctor needs to do a few actions, resulting in the patient just calm down and nausea, vomiting, the doctor also calmly told the patient and family, this is no big risk, the family do not get angry Oh. This is because firstly, this can clarify the diagnosis and help the next step of correct treatment, avoiding detours and using unnecessary drugs; secondly, although this kind of vertigo is painful, most of it is not a big problem, so persistently stick to it, and a minute or two will pass. The name of the disease also shows that it is benign, which is very crucial, indicating that it is firstly safe and rarely leads to serious consequences; secondly, even if you don’t do any treatment and don’t take any medication, you will slowly get better after a few weeks to a few months. However, if you do the reset treatment of the otolith in the hospital, it will help you to recover faster and suffer less from vertigo. This treatment is a bit more complicated, so I won’t explain it in detail, but in general, it is similar to the evocation test, which is also a series of movements. This picture below is the evoked test. I would be satisfied if you can gain a little bit from this article. I hope it will increase your understanding of vertigo.