Vertebrobasilar insufficiency is a very imprecise and much too frequently applied diagnostic term, usually used to classify uncharacteristic intermittent symptoms such as dizziness or visual blurring. Detailed history may make it possible to identify more specific details. Diagnostic attempts nowadays should aim at identifying underlying pathophysiologic mechanisms: intrinsic vessel disease (e.g. atherosclerosis), extrinsic vessel compression (e.g. cervical spondylarthrosis), systemic affections (e.g. anemia, hypotension), or combined etiologies. Accordingly, various therapeutic options exist. Ultrasound examination of the vertebrobasilar system is a reliable screening method in skilled hands, though its sensitivity is lower than in carotid artery disease. To identify the site and nature of the underlying pathology, digital angiography and, probably soon, magnetic resonance angiography (MRA) are available.