<p>Neurological dysfunction is an early marker of sepsis. Cerebral hemodynamic disturbances are frequent in septic and septic shock and may play a key role in the development of sepsis-associated brain dysfunction. Our aim was to assess the existing evidence on the assessment of cerebral hemodynamics in sepsis with the use of transcranial Doppler (TCD). A systematic search of PubMed/Medline, EMBASE and Web of Science was conducted for eligible studies. We included studies published in English up to January 2025 observational and interventional articles using TCD were included. We analyzed data provided by TCD, including middle cerebral artery velocity (MCAv), pulsatility index, cerebral autoregulation indices, cerebral vaso-reactivity, estimated intracranial pressure (eICP), critical closing pressure, and their relationship with clinical outcomes, such as cerebral dysfunction and mortality. This systematic review was recorded in PROSPERO with the ID CRD42023449660. After screening 371 articles, 62 were reviewed in full text, and 29 met the inclusion criteria. A total of 1,087 patients were included, 558 of whom had confirmed septic shock. Mean MCA-v remained within normal limits, cerebral perfusion pressure was relatively low, without an increase in eICP. While cerebral autoregulation was often impaired in septic patients, assessment of cerebral vasoreactivity showed divergent results. The pulsatility index and impaired autoregulation were associated with the occurrence of neurological dysfunction. Cerebral hemodynamics are often altered in sepsis and septic shock and may contribute to neurological alterations observed in such patients. Further randomized trials are needed to identify effective interventions.</p>