A 61 year old gentleman was admitted to the Emergency Department following a witnessed sudden collapse. On initial assessment in the Resuscitation Room, he was noted to be tachycardic (120 bpm) and hypertensive (186/94 mmHg). His GCS was 9 (E2V3M4). There were no external signs of trauma or any other injury. Shortly after admission his GCS deteriorated to 5 (E1V2M2) necessitating intubation and ventilation. A CT head revealed a large intracerebral haemorrhage, with features of raised intracranial pressure and early tonsillar herniation. His condition was discussed with the local tertiary neurosurgical centre, but was deemed inappropriate for neurosurgical or interventional radiological treatment. A decision was made to admit to critical care for neuroprotective supportive care and to facilitate a period of prognostication.