To characterize intracranial hemorrhage in neurosarcoidosis. 

Neurosarcoidosis more commonly manifests with inflammatory complications across the neuraxis, but its cerebrovascular manifestations are increasingly recognized, particularly ischemic stroke. Intracranial hemorrhage is less commonly reported. 

Patients with definite or probable neurosarcoidosis were included if intracranial hemorrhage was present on imaging. 

Eight patients (4 females; 5 Black, 3 white, 1 Asian Indian) were included with an average age of neurosarcoidosis onset of 48 years. Intracranial hemorrhage was an inaugural disease manifestation in 4 (50%), and subtypes included parenchymal microhemorrhage (4, 50%), subarachnoid hemorrhage (3, 37.5%), subdural hematoma (1, 12.5%), and parenchymal macrohemorrhage (1, 12.5%). Most (7, 87.5%) had systemic sarcoidosis; none had cardiac disease. Only two patients were on aspirin at the time of the event (none on anticoagulation). At onset, weakness, sensory loss, and gait impairment were the most common symptoms (present in 4 patients each).  On imaging, inflammatory changes were located in the vicinity of the hemorrhage in 7 (87.5%), most commonly as meningeal (4 or 50% leptomeningeal, 1 or 12.5% pachymeningeal) or parenchymal enhancing lesions (5, 62.5%). Three had vessel imaging (2 MR and 1 CT angiogram), with only one demonstrating left ICA stenosis and possible thrombosis of cortical veins near the hemorrhage. In 5 cases undergoing testing, CSF revealed a pleocytosis in 5 (100%) and elevated protein in 4 (80%, missing data for 1 case). Recurrent microhemorrhages occurred in 2 (25%), and inflammatory relapses occurred in 3 (37.5%). Compared to presentation, the modified Rankin scale score improved in 5 cases (62.5%) and was unchanged in the remainder. 

All forms of intracranial hemorrhage may occur in neurosarcoidosis, typically in association with brain parenchymal or meningeal inflammation, further confirming the potential for sarcoidosis to affect cerebral blood vessels.