This article discusses the clinical presentation of vertebrobasilar ischemia and infarcts. Pertinent dizziness intake questions are presented, as well as key components of the physical examination. The anatomy of the posterior cerebral circulation is discussed as are syndromes associated with cerebrovascular infarcts in the posterior circulation. A high incidence of recurrence of ischemic attacks or infarcts in vertebrobasilar insufficiency is noted. The authors note that recent developments in imaging and interventions may indicate need for referral or consultation with specialists in some cases.