Background <p>Vertebral artery compression syndrome (VACS) is characterized by recurrent and reversible dizziness, consistently triggered by head rotation or hyperextension. Currently, no simple yet effective screening and diagnostic methods are available. This study aimed to explore the application of transcranial Doppler ultrasound with dual transducers (TCD-D) and a head stent in the screening and diagnosis of VACS.</p> Methods <p>From April 2018 to September 2024, three patients with dizziness upon head rotation, diagnosed as VACS, were enrolled. TCD-D was used to simultaneously monitor the real-time blood flow of the bilateral posterior cerebral arteries (PCAs) during the patients’ head rotation. Positional nystagmus was recorded by video goggles at the bedside. Additional examinations were performed to assess the otologic and cervical conditions. Seven control subjects were also included.</p> Results <p>Among the three patients, TCD-D results demonstrated a marked reduction in blood flow of bilateral PCAs upon head rotation, which provoked dizziness. A reactive hyperemic response was observed when the patients returned to the neutral position, supporting the diagnosis of VACS. In contrast, controls demonstrated only mild blood flow changes during non-specific head movements, without dizziness. Downbeat-dominant nystagmus, accompanied by complex horizontal components, was observed in all patients with VACS during head movements.</p> Conclusions <p>TCD-D is an effective, convenient, safe, and cost-effective tool for screening and diagnosing VACS. More importantly, it can be operated in the consultation room and simultaneous recording of positional nystagmus can improve diagnostic accuracy. </p>