Aim To explore functional status of the main arteries of cerebral anterior and posterior circulation system in elderly patients with vascular vertigo, clinical images of cerebral blood flow features were detected and carotid atherosclerosis or plaque were observed. Methods The color doppler flow sonographic features (Siemens Acuson Sequoia 512 ) and transcranial Dopper (TCD) indexes (MT-3000) of carotid arteries in 185 patients with vascular vertigo were observed and evaluated prospectively. Results Simple function change of cerebral anterior or posterior circulation system were found in 14 cases(7.57%) and 42 cases (22.7%) vertigo patients. There was significant difference between the two groups (χ2 =7.67, P<0.01). Both function change of cerebral anterior and posterior circulation system were found in 105 cases (56.8%) vertigo patients. Cerebral atherosclerosis or carotid vessels elasticity decrease is common in 137 cases (74.1%). Carotid atherosclerosis plaques was found in 97 cases (52.4%). The plague was mostly located at the bifureation of the carotid artery, only 3 cases at the vertebrobasilar arterial system. Conclusion Among patients, vascular vertigo occurrence is related not only with the function abnormalities of posterior circulation, but also with the anterior part, even only manifesting with the simple anterior circulation lesion. Atherosclerosis or plaque form is also the most important factor for cerebral circulation insufficiency.