Evoked potentials and brain stem reflex studies in acute ischemic stroke: Applications in clinical practice

The management of patients with acute stroke requires an interdisciplinary approach and strict time management to enable therapeutic decisions in due time. Neurophysiological investigations, with their long tradition in neurological medicine, have undergone a changing role in stroke management since most lesions are now easily and reliably located by modern imaging studies. However, in contrast to conventional MRI and CT scans, evoked potential recordings and brain stem reflex studies provide a functional characterisation of the neural circuits under study and thus remain helpful for the clinician in many instances. Applications include neurophysiological investigations of the brain stem with its many closely neighbouring structures, the monitoring of comatose and sedated patients using multimodal evoked potentials, and studies aiming at determining the prognosis of functional motor deficits using motor evoked potentials. Further, neurophysiological investigations may help in clarifying unusual differential diagnoses and provide additional evidence for normal physiological functioning in cases of suspected psychogenic deficits. This review summarizes in a subjective manner applications of evoked potential recordings and reflex studies that are useful in the management of acute stroke in clinical practice.