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Repetitive TCD monitoring may recognize recanalization during antifibrinolytic therapy for acute ischemic stroke. It provides information about of brain hemodynamics in real time. TCD represents bedside, noninvasive, cheapest, easy repetitive modality which became widely used in patients with cerebrovascular diseases. Since TCD was extensively used in outpatient, intraoperative, and critical care units. Transcranial Doppler ultrasonography (TCD) was first introduced on clinical practice in 1986. TCD is relatively cheap, can be performed bedside, and allows monitoring in acute emergency settings. The physiological information obtained from TCD is complementary to the anatomical details obtained from other neuroimaging modalities. Transcranial Doppler ultrasonography is the only diagnostic modality that provides a reliable assessment of cerebral blood flow patterns in real time. Also, it can be used for evaluation of circulatory arrest with subsequent confirmation of brain death Conclusion Transcranial Doppler ultrasonography is also the unique modality for detection of micro emboli in high-risk patients. Intracranial pressure can be monitored by pulsatility index which reflects blood flow resistance in cerebral vessels.

Cerebral vessels vasospasm represented by abnormal elevation of cerebral blood flow velocity. Many diseases can lead to cerebral vessels vasospasm as in subarachnoid hemorrhage and trauma. Transcranial Doppler is a bedside procedure used to assess cerebral blood flow velocity via cerebral circulation and pulsatility index (PI). The additional information that transcranial Doppler can provide as part of a multimodal imaging protocol in many clinical settings has not been evaluated.