Subarachnoid hemorrhage (SAH) accounts about 10% of all stroke cases with about 50% mortality rate. Most of types of SAH caused by rupture aneurysm. Aneurysmal subarachnoid hemorrhage (aSAH) significantly related to higher morbidity and mortality rate. Increased intracranial pressure is a poor diagnosis of aSAH. Proper outcomes can be achieved in patients with poor–grade aSAH if elevated in intracranial pressure could be controlled. Management of high intracranial pressure (ICP) has been extensively examined in traumatic brain injury (TBI) patients. However, there is lack on the appropriate management of raised ICP in aSAH, particularly in the refractory raised ICP. In this paper, we discussed the role of hypertonic normal saline and mannitol in controlling the elevation in intracranial pressure associated with aSAH.