Pituitary apoplexy is an uncommon, but well recognised clinical syndrome, which usually results from ischaemic or haemorrhagic necrosis of a pituitary adenoma.1 It is characterised by the abrupt onset of severe headache, visual impairment, ophthamolplegia and often, a deteriorating level of consciousness.2 Signs of meningeal irritation are frequent accompaniments, which may confuse the clinical picture with that of aneurysmal subarachnoid haemorrhage (SAH). We report a case of massive SAH caused by pituitary apoplexy and present the CT and MRI findings.

A 72 year old woman, with nothing in her history to suggest pituitary dysfunction, presented with the abrupt onset of severe headache, vomiting, and gradually deteriorating level of consciousness. A CT examination of the brain without contrast enhancement showed an extensive …