Intracranial pressure (ICP) is an important parameter guiding the management of patients in the intensive care unit (ICU) with intracranial pathology. The subdural hemorrhage was evacuated and a right frontal intraventricular ICP catheter was inserted under general anesthetic. ICP has become central to the critical care management of neurologic patients. There are also direct risks associated with the use of monitoring catheters including infection and hemorrhage. Control of ICP in the ICU depends on the manipulation of a variety of factors with the aim of minimizing secondary insults. The management of intracranial hypertension in the ICU requires a multifaceted stepwise approach, with particular care and attention to avoidable complications such as hypoxia, hypercarbia, and hypotension that may dramatically worsen outcome. Rapid control of ICP and resumption of adequate cerebral perfusion pressure (CPP) are the focus of a management strategy, which requires a systematic approach.