Objective: To explore the efficiency of transcranial Doppler ultrasound flow imaging (TCD-FI) combined with amplitude-integrated electroencephalogram (aEEG) parameters in predicting the prognosis of acute stroke. Methods: The data of 121 patients with acute stroke were retrospectively analyzed. Prognosis was evaluated by the modified Rankin Scale (mRS). Patients with an mRS score of less than 2 points were incorporated into the good prognosis group (n=87), and patients with an mRS score ≥ 2 points were enrolled in the poor prognosis group (n=34). General data, TCD-FI cerebral hemodynamic parameters [peak systolic blood flow velocity (Vs), end-diastolic blood flow velocity (Vd), resistance index (RI)], and aEEG brain electrical activity (upper and lower boundary voltages) were compared between the two groups. A receiver operating characteristic (ROC) curve was utilized to analyze the predictive efficiency of TCD-FI combined with aEEG parameters on the prognosis of acute stroke. Pearson correlation analysis was used to analyze the correlation between each parameter and the mRS score. Results: Statistical differences were found in age, infarction size, and degree of vascular stenosis between the two groups (P<0.05). The Vs, Vd, upper boundary voltage, and lower boundary voltage in the poor prognosis group were lower than those in the good prognosis group, while the RI was higher compared to the good prognosis group (P<0.05). ROC curve analysis revealed that the area under the curve (AUC), sensitivity, and specificity of TCD-FI combined with aEEG parameters were 0.873, 52.94%, and 100%, respectively. Correlation analysis showed that Vs, Vd, upper boundary voltage, and lower boundary voltage all exhibited negative correlations with the mRS score (P<0.05), and RI showed a positive correlation with the mRS score (P<0.05). Conclusion: TCD-FI combined with aEEG parameters has high predictive efficiency for the prognosis of acute stroke and can provide a reference for clinical treatment.