Introduction: This prospective clinical study tested the hypothesis that transcranial Doppler ultrasonography (TCD) can be efficiently utilized in the diagnosis and management of tuberculous meningitis-related vasculopathy. Patients and methods: Twenty patients with tuberculous meningitis were assessed with serial TCD examinations. Blood flow velocity (Vm) and pulsatility index (PI) were measured, and findings were correlated with patient prognosis and with clinical and radiological findings. Results and conclusions: The TCD data allowed us to distinguish three phases of tuberculous meningitis-related vasculopathy. In phase I vasculopathy TCD reveals increased Vm and normal to moderately decreased PI. In patients in this phase reversible ischemic deficits are seen clinically and radiologically. Phase II is associated with decreased Vm and decreased PI. At this stage patients reveal radiological and clinical signs related to proximally evolving vasculopathy in the basal main arteries. Phase III is characterized by almost absent blood flow in one or more basal arteries and, accordingly, by associated brain tissue infarction and permanent severe neurological deficit or fatal outcome.