Rare incidence of Pituitary Apoplexy and Intrasellar Aneurysm

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Pituitary apoplexy with aneurysm
Pituitary Apoplexy and Intrasellar Aneurysm

An old lady of 82, presented with sudden onset severe headache associated with multiple episodes of vomiting since 4 hours. On examination her GCS was 15, intact cranial nerves examinations and other neurology.Her Ct scan showed hyperdense lesion in the sella. Provisional diagnosis of pituitary apoplexy was made. Here is her CT scan

So, further investigations like MRI,and MRA done .

It was all suggestive of mixed lesion like pituitary apoplexy and aneurysm.so,CT angio also done.

This showed,intrasellar aneurysm.

Dilemma whether it is an apoplexy or aneurysm bleed?!