Multiple extra-axial calcified lesions and tortuous vessels in a patient with meningioangiomatosis and executive dysfunction.

Meningioangiomatosis (MA) is a rare benign hamartomatous lesion characterized by leptomeningeal and cortical vascular proliferation, and the predominant imaging feature is cerebral calcification. Although the radiological findings of this entity are well known, angiographic characteristics are incompletely understood. This report describes a case of a 54-year-old woman with sporadic MA and lifelong executive dysfunction with novel phase-specific angiographic features. Computed tomography revealed diffuse calcified lesions along the right cerebral convexity. Cerebral angiography showed previously undescribed tortuous vessels in the venous phase without arteriovenous shunting. Despite extensive radiological changes, the patient's neurological status remained stable over a 4-year follow-up period without therapeutic interventions. The identification of frizzy, tortuous cortical veins in the venous phase-previously unreported in MA-serves as a practical imaging sign that can alert clinicians to this rare entity, aid in non‑invasive differentiation from other calcified cortical lesions, and potentially, avoid the need for diagnostic brain biopsy. However, long‑term clinical and imaging follow‑up is mandatory.