Presentation
Sudden onset headache.
Patient Data
Sellar mass with central hyperdensity in keeping with hemorrhage likely within a pituitary macroadenoma (pituitary apoplexy). In addition, there is 4th ventricle hemorrhage.
The sella is enlarged by a cystic mass measuring 20 x 20 x 20 mm which contacts the optic chiasm on its right without significant displacement. Within the pituitary mass, there is a T1 hyperintense and T2 hypointense central area measuring 9 x 11 x 10mm with no appreciable enhancement in keeping with hemorrhage. No diffusion restriction to suggest pituitary infarction.
There is abnormal susceptibility artifact seen at the floor of the fourth ventricle with corresponding high T1 and low T2 signal. No evidence of hydrocephalus.
Case Discussion
This patient had hemorrhage within a cystic pituitary macroadenoma in keeping with pituitary apoplexy. Of note, there is hemorrhage within the floor of the 4th ventricle. Intraventricular hemorrhage associated with pituitary apoplexy has been described in a few case reports, so is subarachnoid hemorrhage. It possibly occurs due to rupture of hemorrhage into the ventricles. It is associated with relatively poorer outcome and so need attention by the neurosurgical team.
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