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.