Intracranial pressure (ICP) is of paramount importance because the cranial vault is nondistensible and within it is contained three noncompressible substances: brain, blood, and cerebrospinal fluid (CSF). This chapter presents a case study of a 75-year-old male who presented for emergent subdural hematoma evacuation. The immediate anesthetic goal was to minimize the rise in ICP while at the same time maintaining adequate cerebral perfusion pressure until the neurosurgeons could provide definitive treatment. Definitive correction of intracranial hypertension was achieved with hematoma evacuation. Intracranial hematomas, blood-filled space-occupying lesions, are classified by their location relative to the meningeal layers. Numerous therapeutic maneuvers exist for lowering ICP, each with the common mechanism of decreasing the volume of one or more intracranial components. increased ICP can be a life-threatening condition, the definitive treatment of which is often in the hands of the neurosurgeon.