Vertebral artery testing and differential diagnosis in dizzy patients

The vertebral artery test (VAT) is often used during the physical therapy examination but its validity as a clinical test of arterial patency is a topic of debate. When examining patients with dizziness, a modified VAT (mVAT) is routinely used to minimize angular changes of the ear limiting stimulation of the vestibular system. The mVAT can be helpful in the differential diagnostic process as dizziness can result from pathologies including vertebrobasilar insufficiency and vestibular disorders such as benign paroxysmal positional vertigo. The purpose of this paper was to review the debate surrounding the VAT and to propose using the mVAT as a test of cervical positional tolerance versus vertebral artery patency when examining dizzy patients.