Case ReportPituitary apoplexy presenting as an intraventricular hemorrhage: An infrequent neurovascular emergency

•Pituitary macroadenomas may debut with a pituitary apoplexy.•Pituitary apoplexy hemorrhage can be mistaken for an aneurysmal rupture, especially if it extends into the ventricles.•Hemorrhage within the pituitary tumor may be the result of disproportionate growth in relation to blood flow.

Pituitary macroadenomas may present with a pituitary apoplexy, commonly with associated hemorrhage, but rarely large enough to show an intraventricular bleeding. This is a case report of a 66-year-old woman with a 3-month history of headache, hyporexia, asthenia and altered consciousness. First evaluations showed a large intraventricular hemorrhage on CT scan that was initially misdiagnosed for an aneurysmal rupture etiology but later confirmed to be a pituitary apoplexy from a large pituitary adenoma. Intraventricular hemorrhage due to a pituitary apoplexy could be mistaken for an aneurysmal origin thus warranting for a careful evaluation of the sellar region.