Pontine hyperintense lesions. It is fairly common to encounter areas of increased signal on T2 MRI in the pons. These patients often display symptoms of disequilibrium, difficult with speech and swallowing. In the author's experience, these patients often exhibit rebound nystagmus, which is a variant of gaze-evoked nystagmus . While MRI technology has advanced greatly, MRA is presently not of high enough resolution to reliably visualize the tiny arteries involved in this area.
Conventional angiography is the most reliable way to infer the diagnosis.
Death from respiratory failure is common. Carotid Occlusion Carotid disease rarely causes vertigo. When carotid disease is severe, and accompanied by disease in the back arteries, carotid disease can be associated with vertigo, but this is unusual. Diagnosis is via MRA, doppler, or angiography. The brainstem graphic is courtesy of Northwestern University.