Forty-four transcranial Doppler ultrasound studies were performed in 36 dogs. The ratio of the height of the ventricle to the height of the brain (VB ratio) was calculated to determine the severity of ventriculomegaly. Resistance index (RI) was calculated from Doppler measurements of the blood flow velocity in the basilar artery and neurologic signs were scored on a scale of 0 to 3. Based on clinical and ultrasonographic findings, dogs were divided into four groups (normal controls, asymptomatic hydrocephalus, symptomatic hydrocephalus, and other intracranial disease). RI and VB ratio were compared between the groups of dogs and compared with neurologic signs in hydrocephalic dogs. RI ranged from 0.50 to 0.81 (mean, 0.68). Resistance index was significantly higher in dogs with symptomatic hydrocephalus and other intracranial disease when compared with the other two groups. The degree of ventriculomegaly was significantly higher in dogs with symptomatic hydrocephalus than the other groups, but there was substantial overlap between asymptomatic and symptomatic hydrocephalus groups. Combining measurements of VB ratio and RI allowed detection of symptomatic hydrocephalus with a sensitivity of 77% and a specificity of 94%. The severity of neurological signs was significantly correlated with RI and with VB ratio in hydrocephalic dogs, and in dogs evaluated on more than one occasion, changes in neurologic status were accompanied by changes in RI but not in VB ratio. All asymptomatic hydrocephalic dogs with a VB ratio of greater than 60% eventually developed neurologic signs. Our results suggest that ultrasonographic measurement of VB ratio and basilar artery RI may allow identification of dogs with symptomatic hydrocephalus or dogs that are at risk of developing symptomatic hydrocephalus. Repeated RI measurements are a useful means of monitoring dogs with a variety of intracranial diseases.