A 29-year-old Nigerian female developed fever, severe back pain, photophobia and severe meningismus five months postpartum. After multiple consultations, lumbar puncture revealed WBC 203 (0-5/mm³) with 85% lymphocytes, protein 85, elevated IgG synthesis rate. Oligoclonal bands and infectious workup were negative. Neuroimaging revealed diffuse leptomeningeal enhancement involving the bilateral internal auditory canals, left trigeminal and glossopharyngeal nerves, anterior cervicomedullary junction. Spinal cord imaging revealed enhancement within the lower thoracic cord and of the conus medullaris. Comprehensive evaluation with CT scans revealed no evidence of systemic sarcoidosis. High dose intravenous steroids were administered with suspected inflammatory disease with significant improvement. CSF Angiotensin conversion enzyme (ACE) levels were elevated (3.6). Repeat images showed resolution of enhancing lesions. She was then transitioned to hydroxychloroquine with steroid taper. Five months after neurosarcoidosis diagnosis, she had another pregnancy resulting in abortion at six weeks, stopped hydroxychloroquine with worsening of prior urinary symptoms, since subsided after reinitiation of hydroxychloroquine. She subsequently continued her hydroxychloroquine throughout her third pregnancy with considerations for postpartum empiric treatment and close radiologic monitoring.