The presence of intra cranial hypertension after traumatic brain injury (TBI) affects patient outcome and calls for prompt recognition and treatment. Accurate monitoring of intra cranial pressure (ICP) is therefore essential in neuro intensive care. However, It is not readily available in most Neuro ICU settings in our country. This extremely valuable tool and technique is available in our ICU and used judiciously with improved outcome in patients operated for head injury , brain tumours and brain haemorrhage.