This report addresses whether intracranial pulse pressure amplitudes are associated with brain energy metabolism, examined by intracerebral microdialysis. We present a 65-year-old female with an aneurysmal subarachnoid haemorrhage (SAH) from a left posterior communicating artery (PCOM) aneurysm. She underwent simultaneous intracranial pressure (ICP) monitoring and microdialysis (MD) as part of a diagnostic workout because of a lack of clinical improvement after long-term intensive care management. Over a 4-day period, a total of 128 samples of metabolites (glutamate, glycerol, lactate and pyruvate) were gathered, allowing retrospective comparisons with the levels of intracranial pulse pressure amplitudes (the mean ICP wave amplitude). During this 4-day period, mean ICP was normal (<15 mmHg), while mean ICP wave amplitude was high (>/=5 mmHg) in 47% of the recording time. There was a highly significant relationship between the levels of the mean ICP wave amplitude and the levels of glutamate, glycerol and lactate/pyruvate ratio. The levels of metabolites were increased when the mean ICP wave amplitude was >/=5 mmHg as compared with mean ICP wave amplitude levels <5 mmHg. We tentatively suggest that increased mean ICP wave amplitudes indicative of reduced intracranial compliance can be associated with brain ischaemia.