The cerebral hemodynamic evaluation is the embodiment of a system approach to the hemodynamic factors that affect brain blood flow. The stresses employed are those encountered in everyday living. The instruments are simple and the method is basic. The importance of the cardiovascular response to the upright position and of brain perfusion to head motion deserves close attention in the clinical setting. The CHE complements the angiogram, the CT scan, and CT-rBBC studies by addressing the system and arterial hemodynamic factors affecting brain circulation. The CT-rBBC studies have given greater validity and direction to noninvasive and electrophysiologic testing because the ultimate concern is brain perfusion and function and not the angiogram. This combination of techniques has defined the role of the dynamic arterial obstruction and the vertebral artery in the hemodynamics of the brain. The cerebral hemodynamic evaluation is an integral part of the physiologic approach to the diagnosis and treatment of brain ischemia.