Ucb, a 38-year-old woman, presented with a history of a subacute onset of migraine­pattern headache, characterized by pulsating pain of high intensity, associated with nausea and photophobia, without aura symptoms. Initially, the pain lasted from hours to days, but it progressed to chronicity, with daily headaches. In addition to the headache, the patient reported worsening vertigo and gait ataxia that had been progressively deteriorating. During the rst few months, she attended several emer­gency departments, being treated for a diagnosis of migraine. When the episodes began to exhibit signs and symptoms of cerebellar origin vertigo, such as multidi­rectional and non-fatigable nystagmus, axial ataxia, and accentuated limb ataxia, the patient underwent further investigation with a magnetic resonance imaging (MRI) of the brain, which revealed leptomeningeal enhancement in the brainstem and cerebellum (see Fig.32.1). Extending the investigation with MRI of the spinal column also showed altered contrast enhancement at the cervical spinal cord level (see Fig.32.1). A lumbar puncture was performed, revealing pleocytosis (93 cells) with a predominance of lymphomonocytic cells, as well as an increase in protein content in the sample (223g/L). Following a hypothesis of granulomatous disease, screening for other systemic inammatory foci was conducted, which returned neg­ative. This led to a meningeal biopsy, which, in addition to the clinical ndings, conrmed the diagnosis of neurosarcoidosis, as it found non-necrotizing granulo­mas, with no other foci of systemic disease identied.