Resolving a “W-Shaped” P100 Waveform: Is It Normal or Abnormal?

Abstract

Summary: Pattern-reversal visual evoked potentials are used to assess the visual pathways. The main waveform of interest is the P100, which is best recorded with electrodes over the mid-occipital region. Most often, the P100 waveform has negative–positive–negative components. Occasionally, it is “W-shaped,” with positive–negative–positive components. Although most often a W-shaped P100 waveform indicates an abnormality in the visual pathway, occasionally, it can be normal. A case is presented in which a W-shaped P100 waveform is seen after monocular full-field stimulation of both eyes with 30′ checks. To resolve this finding, the pattern-reversal visual evoked potentials is repeated with 60′ and 15′ checks. With 15′ checks a single typical single-peak P100 waveform is seen with normal latency. Evaluation of a W-shaped P100 waveform should involve analysis of various montages, stimulation with different check sizes, and hemifield stimulation to confirm whether the W-shaped waveform is normal or abnormal.