Due to the MRI findings, a stereotactic biopsy was performed by the treating neurosurgical team.

Meningothelial hyperplasia is a poorly characterized entity and occasionally causes diagnostic difficulties due to its overlapping histologic features with meningioma. It is a reactive process characterized by a proliferation of meningothelial cells that reaches a thickness of ten or more cell layers with PR positivity, which is not seen in normal cells.

In this case, the brain MRI shows remarkable accentuation of the parenchymal vessels throughout the full thickness of the cortex and white matter. 

The relationship between the vascular attenuation and the histological finding of meningothelial hyperplasia is unclear and a causal relationship has not been firmly established. 

This case was presented in Eurorad.