Case Report

When two bleeds collide: Pituitary apoplexy masking a ruptured intracranial aneurysm

Tavonga P.C.S. Bayela, Suzanne O'Hagan, Christelle Ackermann
South African Journal of Radiology | Vol 30, No 1 | a3479 | DOI: https://doi.org/10.4102/sajr.v30i1.3479 | © 2026 Tavonga P.C.S. Bayela, Suzanne O’Hagan, Christelle Ackermann | This work is licensed under CC Attribution 4.0
Submitted: 31 March 2026 | Published: 14 July 2026

About the author(s)

Tavonga P.C.S. Bayela, Division of Radiodiagnosis, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Suzanne O'Hagan, Division of Radiodiagnosis, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Christelle Ackermann, Division of Radiodiagnosis, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

Abstract

Concurrent pituitary apoplexy and ruptured intracranial aneurysm are rare, but potentially fatal, if unrecognised. A 53-year-old hypertensive woman presented with acute confusion and transient hemiparesis. Brain CT demonstrated a haemorrhagic sellar–suprasellar mass with atypical subarachnoid and intraventricular haemorrhage. CT angiography (CTA) confirmed a ruptured right middle cerebral artery (MCA) aneurysm and two additional unruptured aneurysms. Subsequent endovascular coil embolisation was successful. The pituitary macroadenoma was managed conservatively.
Contribution: Early recognition using haemorrhage pattern analysis and CTA is critical to avoid missed dual pathology in pituitary apoplexy and to guide timely management.


Keywords

pituitary apoplexy; intracranial aneurysm; subarachnoid haemorrhage; CT angiography; MRI; digital subtraction angiography

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