Continuous intraventricular monitoring of intracranial pressure appears to be a useful aid in the management of patients with Reye syndrome, especially those in stage 3 or 4 coma, in which the mortality rate remains high. Elevations in intracranial pressure can be treated promptly and before the patient shows clinical signs of deterioration. Careful attention to adequate airway care is essential. The use of paralytic agents to reduce pressure secondary to muscle movement is useful. The minimum dose of mannitol required can be carefully titrated, and sudden pressure changes can be combated by release of small amounts of cerebrospinal fluid.