Abstract
Vascular-associated intracranial calcification is an uncommon neuropathological finding that may present with heterogeneous neurological manifestations and occasionally mimic an intracranial tumour. Definitive diagnosis may be particularly challenging when ante-mortem neuroimaging is unavailable. A 31-year-old man presented with progressive neurological deterioration and was clinically suspected of having an intracranial tumour. Computed tomography and magnetic resonance imaging were recommended but declined by the patient. Following death, complete autopsy with detailed neuropathological examination demonstrated extensive bilateral vascular-associated and parenchymal intracranial calcification involving small- and medium-sized cerebral vessels, accompanied by vascular sclerosis, cerebral oedema, neuronal injury, and reactive gliosis. No histopathological evidence of intracranial neoplasia was identified. The findings resolved the discrepancy between the ante-mortem clinical suspicion of an intracranial tumour and the post-mortem diagnosis. This case emphasises the importance of considering extensive intracranial calcification in the differential diagnosis of progressive neurological deterioration and highlights the value of clinicopathological correlation when neuroimaging, comprehensive metabolic evaluation, and genetic testing are unavailable.