We present a case of a 46 year old male who presented with sudden onset intractable headache. The patient reported the headache began abruptly and at maximal intensity approximately 4 months prior to examination. This headache was associated with episodes of severe vertigo lasting seconds to minutes. The patient underwent imaging which showed extensive punctate enhancement involving the structures in the posterior fossa, most pronounced in the vermis of the cerebellum. The patient underwent lumbar puncture which showed significantly elevated protein at 225 mg/dL, 125 WBC at 90% lymphocytes, 16 RBCs, and decreased glucose of 24 mg/dL and negative oligoclonal bands. The patient underwent extensive testing for aseptic meningitis to rule out a viral, tuberculous, or neoplastic etiology. CT scan of the chest was performed which showed mild hilar lymphadenopathy which was subsequently biopsied and demonstrated non-necrotizing granulomatous inflammation. The patient was started on methotrexate and prednisone for definite neurosarcoidosis per Zajicek criteria.