“…1,17 Indications for immediate treatment of sarcoidosis are generally recognized as functional respiratory impairment or extrapulmonary manifestations including neurological, cardiac, or renal involvement, ocular disease refractory to topical therapy, or symptomatic refractory hypercalcaemia 1,15,16,18 Immediate treatment for patients with confirmed systemic sarcoidosis with evidence of CNS involvement has been advocated, 4,15,16,18 as unlike pulmonary sarcoidosis spontaneous resolution of neurosarcoidosis is rare, and there is significant risk of morbidity and mortality. 19 Treatment with corticosteroids, typically 1 mg/kg/d is first line for neurosarcoidosis. For patients presenting with severe disabling disease such as brain or spinal cord lesions, leptomeningeal involvement or hydrocephalus, aggressive management with pulsed IV methylprednisolone followed by prolonged corticosteroid wean over six to twelve months is recommended.…”