Intraoperative neurologic monitoring has been the subject of intense research for many years, the goal being to accurately identify intraoperative cerebral ischemia, and predict which patients may benefit from intraoperative shunting. This chapter presents a case study of a 73-year-old male scheduled for a right carotid endarterectomy (CEA) under general anesthesia. The patient experienced delayed emergence and displayed signs of a left hemiparesis. A diffusion-weighted magnetic resonance imaging confirmed the presence of a right-sided ischemic stroke in the middle cerebral artery (MCA) territory. For patients undergoing CEA under general anesthesia a number of monitoring modalities exist: monitors of cerebral hemodynamics, monitors of cerebral oxygenation and metabolism, and monitors of electrophysiologic parameters. None of the monitoring modalities commonly used for CEA under general anesthesia have been shown to either reliably identify or prevent cerebral ischemia or stroke, nor predict which patients may benefit from shunt placement.