How would this patient most likely have presented?
Sudden onset severe headache and visual loss. May also have depressed conscious state.
What early complication is evident, which will contribute to headaches?
Hydrocephalus, due to distortion of the third ventricle and foramina of Munro.
Look carefully at the coronal sequences. What is the relationship of the optic chiasm to the mass?
The optic chiasm is elevated and stretched over the anterior part of the mass, with the more posterior and superior component extending between the optic tracts (see next images).
There is a large multi-lobulated mass with intrinsic high T1 signal and heterogeneous T2 signal, including large areas of signal drop out. The mass appears to arise from the pituitary fossa which is significantly expanded, and extend superiorly invaginating into the third ventricle. The outflow of the lateral ventricles is compromised with evidence of hydrocephalus and transependymal oedema.
The optic chiasm is elevated and stretched over the anterior part of the mass, with the more posterior and superior component extending between the optic tracts.