Neuropathological evidence for neurosarcoidosis is more widespread than imaging suggests

We present a single case of a 47 year old male with a relapsing progressive neurological disease characterised by an infiltrative inflammation of the brain and leptomeninges. Investigations revealed the presence of systemic sarcoidosis which was confirmed histologically following a mediastinal lymph node biopsy. The imaging appearances of the brain and spinal canal lesions were compatible with neurological involvement by the same disease. Despite treatment, the patient deteriorated and died. We present the neuropathological findings, correlate these with the imaging features, and find that neuropathological evidence for disease was in this case strikingly more widespread than predicted by imaging ante-mortem.