Headache and papilledema: A case of neurosarcoidosis with cerebrovascular involvement

Cerebrovascular involvement of neurosarcoidosis is a rare albeit increasingly recognized disorder requiring a multidisciplinary approach to diagnosis and management. We present a case of systemic sarcoidosis with neurological involvement of brain parenchyma and intracranial vasculature, and discuss a step-wise approach to the diagnostic evaluation. An inflammatory vasculitis should be considered in a patient with confirmed or highly suspected sarcoidosis with ischemic stroke. MR angiography with vessel-wall imaging should be pursued early in the evaluation to support this diagnosis. Cerebrovascular complications of sarcoidosis are often responsive to sarcoid-related immunotherapies.