Patient presents with suspected neurosarcoidosis, a rare granulomatous disorder of the central nervous system.  Differential diagnosis includes multiple sclerosis, lymphoma, meningitis, and other neurological conditions.  Presenting symptoms include but are not limited to cranial neuropathies, particularly facial nerve palsy, optic neuritis, headache, seizures, ataxia, cognitive impairment, and myelopathy.  Neurological examination findings may reveal focal neurological deficits, altered mental status, and signs of meningeal irritation.  Diagnostic workup includes MRI brain and spine with and without contrast, demonstrating characteristic enhancing lesions.  Cerebrospinal fluid analysis may reveal elevated protein, lymphocytic pleocytosis, and occasionally, low glucose.  Neurosarcoidosis diagnosis often requires exclusion of other etiologies and may necessitate biopsy, although this is not always feasible or conclusive.  Treatment typically involves corticosteroids, such as prednisone, as first-line therapy.  Immunosuppressive agents like methotrexate, azathioprine, or mycophenolate mofetil may be considered for steroid-sparing or refractory cases.  Infliximab and other biologic therapies are sometimes utilized in severe or recalcitrant neurosarcoidosis.  Patient education regarding the chronic nature of the disease, potential complications, and medication side effects is crucial.  Follow-up neurological evaluations and imaging studies are essential for monitoring disease activity and treatment response.  ICD-10 code D86.89 is appropriate for neurosarcoidosis.  Medical billing and coding for neurosarcoidosis may involve evaluation and management codes, neurology consultation codes, and imaging and laboratory procedure codes.