Stroke is a major cause of morbidity and mortality in children with sickle cell disease (SCD), affecting 7% to 11% of these children. The strongest risk factor for stroke in children with sickle cell disease is an elevated mean cerebral blood flow velocity above 180cm/sec and 200cm/sec using an imaging machine and a non-imaging machine respectively. This high flow velocity is associated with a 10% risk of stroke in the subsequent 12 months. Transfusion based on transcranial doppler (TCD) ultrasound screening reduces the risk of stroke in children with sickle cell anaemia (SCA). Despite its proven benefits, TCD screening has not become the standard of care in most facilities providing care for children with sickle cell anaemia, especially in the developing countries due to lack of necessary equipment and trained personnel. Consequently, there is a paucity of data on the prevalence and pattern of TCD changes in patients with SCA in Nigeria. The study was thus undertaken to identify the local Transcranial Doppler scan imaging technique (TCDI) patterns and to highlight any similarities and differences to what obtains in other settings that might be useful and applicable in the clinical care of children with SCA. This study was a comparative cross sectional study in which55 children, aged 2 to 16 years with sickle cell disease (SCD) comprising 49 HbSS and 6 HbSC children and equal number of age and sex matched apparently healthy children with haemoglobin genotype AA were recruited over a six month period. Study participants were recruited from the sickle cell disease clinic and those with HbAA from the paediatric outpatient clinic. All eligible study participants had blood sample taken for full blood count and differentials, reticulocyte count and percentage sickled cells using an automated blood analyzer model/Sysmex KX-21N® and genotype confirmation using haemoglobin electrophoresis and subsequently scheduled for transcranial doppler scan. Transcranial doppler ultrasonography was done using imaging Doppler ultrasound machine (Chison ivis 60 plus digital colour Doppler ultrasound system). The data obtained were analysed using SPSS 20.0 software package. The variables were presented and subjected to appropriate statistical tests to determine their significance.