The high incidence of oto-vestibular complaints in patients presenting vertebro-basilar insufficiency (VBI) is emphasized. In some studies up to 90% of the patients are complaining from dizziness, oscillopsia or tinnitus. The indications of the oto-vestibular evaluation and its importance in the diagnosis of VBI is discussed. The authors lay stress on the fact that the Romberg test is not valuable as a vestibular functional screening test, but that only a full oto-vestibular evaluation will contribute to the diagnosis of VBI.