Neurosarcoidosis Presenting With Cerebellar Hemorrhage and Spinal Cord Involvement: A Case Report.

Neurosarcoidosis is a rare manifestation of sarcoidosis, a systemic granulomatous disease. It presents a diagnostic challenge due to its varied clinical and radiologic features. We describe a 37-year-old male with biopsy-proven pulmonary sarcoidosis who developed progressive neurological symptoms, including dizziness, imbalance, diplopia, and lower extremity weakness. MRI revealed diffuse leptomeningeal enhancement, cervical spinal cord lesions, and left cerebellar hemorrhage with surrounding vasogenic edema, a relatively rare finding in neurosarcoidosis. Cerebrospinal fluid (CSF) analysis showed inflammatory changes, and mediastinal lymph node biopsy confirmed non-necrotizing granulomas. The patient was treated with high-dose corticosteroids followed by immunosuppressive therapy, leading to gradual improvement in gait and strength. This case highlights the importance of recognizing neurosarcoidosis as a potential cause of central nervous system hemorrhage. Cerebrovascular involvement, particularly intracerebral hemorrhage, is underrecognized but can have serious consequences, making early diagnosis and aggressive immunosuppressive therapy critical in preventing long-term neurological deficits.