CT head: a large right-sided fronto-parietal ICH with extension into the basal ganglia, right cerebral peduncle, and midbrain is seen. Subfalcine herniation and effacement of basal cisterns is visible. Multimodal neuromonitoring: the vertical line demarcates the onset of the Cushing reflex with bradycardia and hypertension (top two panels). Before the AP increase, asymmetrical changes in THI, thought to represent significant intracranial volume shifts, are visible (arrow). There is a global increase in TOI thought to represent venous outflow obstruction or reduced metabolic demand on both sides (bilaterally). TCD recording form the middle cerebral artery demonstrates diastolic reversal of flow before (left panel) and during (right panel) the Cushing reflex. AP, arterial pressure; HR, heart rate; MCA, middle cerebral artery; TOI, tissue oxygenation index; THI, tissue haemoglobin index.