We report a presentation of relapsing and remitting isolated intracranial neurosarcoidosis in a female patient who presented with episodic severe headache and behavioural disturbance initially misdiagnosed as psychosis. Eventually, several episodes were accompanied by visual disturbance secondary to papilloedema, ultimately leading to a diagnosis of neurosarcoidosis on meningeal biopsy.

Sarcoidosis is a multisystem inflammatory disease of unknown aetiology, and is characterised by non-caseating granulomata. Pulmonary disease is the most common manifestation, occurring in 90% of patients. Clinical involvement of the nervous system is said to occur in 5–15% of patients.¹ Isolated intracranial neurosarcoidosis is even rarer, with systemic sarcoidosis being detected in more than 95% of cases of sarcoidosis initially presenting with neurological symptoms.²

Case report

A woman presented initially at age 30 years, and then subsequently five times over 3 years with stereotyped episodes of headache, confusion and psychomotor agitation. In each instance, a history was given of a constant, severe bifrontal headache that was associated with nausea, vomiting, photophobia and/or visual field disturbance. As each presentation evolved, she became confused and encephalopathic. Early in the course of her illness these episodes were misinterpreted as acute psychosis because she exhibited pressured …