Physical examination of a critically ill patient with acute primary or secondary neurological injury is often insufficient for medical decision making. Transcranial Doppler/transcranial color coded sonography (TCD/TCCS) is a useful physiologic tool allowing one to individualize the management of each patient to optimize cerebral hemodynamics. 2. Pulsatility index (PI) is calculated by subtracting the peak systolic velocity (PSV) from the end diastolic flow velocity (EDV) and dividing the difference by the mean flow velocity (MVF); [PI = (PSV − EDV)/MVF]. 3. Pulsatility Index is dependent on multiple variables including cerebrovascular resistance (CVR). 4. Despite the correlative value of PI obtained from TCD/TCCS, the external ventricular drain remains the gold standard in the measurement of intracranial pressure (ICP).