Patients with intracranial pathology have decreased intracranial elastance and are at risk for exaggerated increases in intracranial pressure (ICP) with small changes in intracranial volume. This chapter presents a case study of a 54-year-old female with a past medical history significant for hypertension and bilateral carotid artery stenosis who presented with an acute right middle cerebral artery (MCA) ischemic infarct. The mechanism of increased ICP can be attributed to cytotoxic and vasogenic edema. Cytotoxic edema refers to the shift of water from extracellular to intracellular compartments. High-dose intravenous steroids reduce the permeability of the blood-brain barrier and have been effective in reducing edema surrounding intracranial tumors. Agents used include pentobarbital, thiopental, propofol, and benzodiazepines. While pharmacologic coma has been shown to reduce ICP, there are currently no proven benefits on overall morbidity and mortality. The risk of intervention must be balanced against the risk of prolonged, untreated increases in ICP.