Neurological involvement is a significant cause of morbidity and mortality in patients with sarcoidosis. The aim of this study was to evaluate the role of magnetic resonance imaging (MRI) in the diagnosis of patients with neurosarcoidosis. The MRI brain scans of 22 patients with sarcoidosis were retrospectively reviewed, along with the clinical information provided in the request form. All patients had signs and symptoms referable to the head and were examined with gadolinium enhancement. Cranial (facial) nerve paralysis was the most common clinical manifestation identified in 10 patients. A wide spectrum of MR findings was noted: periventricular and white matter lesions on T2 W spin echo images, mimicking multiple sclerosis (46%); multiple supratentorial and infratentorial brain lesions, mimicking metastases (36%); solitary intraaxial mass, mimicking high-grade astrocytoma (9%); solitary extraaxial mass, mimicking meningioma (5%); leptomeningeal enhancement (36%). The diagnosis of neurosarcoidosis is often difficult, particularly so in patients who lack either pulmonary or systemic manifestations of sarcoidosis. MRI shows a wide spectrum of brain abnormalities associated with neurosarcoidosis. These findings, however, are not specific for sarcoidosis and one must consider appropriate clinical circumstances in arriving at the correct diagnosis. In selected cases with isolated brain involvement, meningeal or cerebral biopsy may be required.