Elevations in intracranial pressure (ICP) constitute neurological emergencies, and a significant amount of time in the neurological critical care unit (NCCU) is spent diagnosing and treating increased ICP. It is pivotal to understand the signs of increased ICP, and treatment should be implemented without delay. Most institutes utilize an algorithmic-based approach for ICP management. This chapter will review the etiologies and diagnosis of increased ICP and will summarize our treatment algorithm. The available evidence for each intervention will be discussed.