Objective To study the common etiological components and bedside diagnostic skills of isolated transient vertigo (ITV).Methods We performed a single-center observational study that had consecutively recruited 424 middle-aged and elderly patients presenting with vertigo episodes lasted less than three minutes in the Neurology Department of Shanghai Tongji Hospital from January 2018 to January 2020.The clinical characteristics were collected and analyzed according to the established format and vertigo causes were analyzed.Binary Logistic regression analysis was used to determine some clinical parameters to benign paroxysmal positional vertigo (BPPV) and vascular ITV (vITV).Results In all 424 patients,BPPV accounted for 65.09% (n=276),vITV for 20.51% (n=87).Fifty-two cases (18.84%) of BPPV were diagnosed as posterior circulation ischemia (PCI) and 12 cases (14.63%) of vITV were suspected as BPPV.Logistic Regression analysis showed that onset time of vertigo<30 s,vertigo provoked by lying down or turning over in the supine position and typical nystagmus by positional maneuver were the independent predicted factors of BPPV (P<0.001).The higher risk of vITV was found in association with intolerance of head movement,trunk balance disturbance,spontaneous nystagmus and intolerance by positional maneuver (P<0.001).There was no independent correlation between vascular risk factors and vITV (P>0.05).Conclusion BPPV and vITV are the most common etiologies of ITV in the middle-aged and elderly patients.The etiology of ITV can be quickly and effectively distinguished by some specific clinical features and target bedside examinations.