Background : Thrombo-embolic episodes (TEE) occurred 4.38 times more frequently in thalassemia intermedia (TI )than thalassemia major (TM), The prevalence of overt strokes in TI patients with a history of thrombosis ranges between 5% and 9%. Thrombosis in splenectomized TI patients is a chronic process. Aim of the work : This study aimed at detecting the prevalence of silent stroke in TI using MRI and TCD . Patients and Methods : Fifty TI patients ( age range 5 to 34 years with mean age of 11.2 ± 5.72 years) fulfilling the inclusion criteria underwent history taking , clinical examination , laboratory investigations and imagings (MRI, TCD) after providing a verbal consent. Results : Steady Hb level ranged from 7 to 9.5 g/dl with mean of 8.25 ± 0.52 g/dl. Frequency of blood transfusions to maintain that Hb level ranged from 0 to 60 months with mean duration of 4.78 ± 11.77 months . Thirty six (72%) patients were on HU, on a compliance dose 20.8 ± 3.8 mg/kg/day. Only 7 (14.85%) were splenectomized within maximum period of 2 years. The examination of right and left MCAs of forty seven TI patients resulted into 94 total TCD examinations, 64(68%) showed PSV above normal for age while, 70 examinations (74.4%) showed MV above normal for age ; suggesting MV sensitivity over PSV.TCD velocities showed negative correlation with age at diagnosis (P≤ 0.05) as well as at time of examination (P≤0.05). Six (85%) out of the 7 splenectomized patients had high TCD velocity for age . Both blood transfusion frequency and HU duration of compliance showed negative correlation with TCD velocities for further longitudinal studies. Conclusion, TCD is a sensitive tool to be used for early detection of stroke (silent or overt). The presence of high TCD velocities for age in TI may suggest the presence of a risk to develop stroke (silent or overt).