title: Clinical diagnosis of vertebrobasilar insufficiency: resident's case problem.
abstract: METHODS
  Resident's case problem.
  
  
  BACKGROUND
  Vertigo and visual disturbances are common symptoms associated with vertebrobasilar insufficiency (VBI), but the physical examination procedures to verify the existence of VBI have not been validated in the literature. The objective of this resident's case problem is to demonstrate how a patient's complaint of vertigo and visual disturbances, combined with positive clinical examination findings, can be a potential medical screening tool for VBI.
  
  
  METHODS
  The patient in this report was initially referred to physical therapy for neck pain. However, the patient's chief concerns identified during the history were (1) vertigo, (2) visual disturbances, (3) headache, and (4) right shoulder region pain. Clinical VBI tests were performed, whereby the patient's vertigo and visual disturbances were reproduced with cervical spine extension. The patient was sent back to the referring physician to be evaluated for possible VBI. Diagnostic imaging tests were ordered. Carotid ultrasound revealed 80% to 90% stenosis in the proximal left internal carotid artery, and magnetic resonance angiography of the extracerebral vessels showed greater than 90% stenosis of the left internal carotid artery.
  
  
  CONCLUSIONS
  VBI may be present in patients with subjective reports of vertigo and visual disturbances that are reproduced with VBI physical examination procedures.
authors.affiliation: Kaiser Permanente Southern California, Orthopaedic Physical Therapy Residency, Los Angeles, CA 90027, USA. Skulpan.X.Asavasopon@kp.org
authors.forename: Skulpan
authors.initials: S
authors.lastname: Asavasopon
authors.forename: John
authors.initials: J
authors.lastname: Jankoski
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Godges
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology; D026741:Physical Therapy Modalities / Q000193:education; D020069:Shoulder Pain / Q000209:etiology; D014715:Vertebrobasilar Insufficiency / Q000150:complications / Q000175:diagnosis*; D014717:Vertigo / Q000209:etiology; D014786:Vision Disorders / Q000209:etiology