Pituitary macroadenoma complicated by subarachnoid hemorrhage after transphenoidal surgery: worsened right arm weakness, new rigidity. There are postoperative findings related to transphenoidal surgery. There is a heterogenous sellar and suprasellar mass that measures up to 35 mm, previously 45 mm, with areas of T1 hyperintensity and susceptibility effect, compatible with recent hemorrhage. There is also hemorrhage within the left suprasellar and basal cisterns, bilateral Sylvian fissures, posterior temporal convexities, upper cerebellar sulci, and within the occipital horns of the bilateral lateral ventricles. In addition, hemorrhage is also present within the sinonasal cavities. There is scattered cerebral white matter T2 hyperintensity, which is nonspecific. There is no evidence of acute infarction. There is no midline shift or herniation. The ventricles appear to be more prominent diffusely. The major cerebral flow voids appear to be grossly intact. There is fluid within the bilateral mastoid air cells. The orbits are grossly unremarkable.
Interval evolution of recent hemorrhage within the pituitary macroadenoma, which has overall decreased in size, with persistent subarachnoid and intraventricular extension, as well as developing hydrocephalus. Hemorrhage is also present within the sinonasal cavities.