Chronic hydrocephalus as a sequela of subarachnoid hemorrhage is a complication that neurosurgeons battle with every day. This chapter presents a case study of a 49-year-old female presented to the hospital with fever and altered mental status. Computed tomography (CT) scan of the head revealed acute hydrocephalus, with ventriculomegaly and hypodensity in the surrounding whitematter representing transependymal translocation of cerebrospinal fluid (CSF). The diagnosis of acute hydrocephalus is made based on CT scan evidence of subarachnoid hemorrhage (SAH) or intraventricular blood, with or without the presence of enlarged ventricles, as well as a declining mental status. As the popularity of endovascular treatment of ruptured cerebral aneurysms has grown, there has been speculation that this treatment modality results in a higher incidence of shunt-dependent hydrocephalus. Although necessary for the treatment of chronic hydrocephalus, ventriculoperitoneal shunt (VPS) are fraught with complications.