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Our patient presented initially at the age of 59 in 2012 to the Neurology service with abnormal movements with a background history of fibromyalgia and chronic fatigue syndrome. The movements were felt to be choreiform in nature, and allowing for her diagnosis of CFS the rest of the neurological examination was normal. Her initial MRI revealed abnormalities in the basal ganglia and differentials of extrapontine myelinolysis, Wernicke’s and small vessel disease were raised. In 2016 she presented with deterioration in cognition followed a by a seizure and reduced GCS. Repeat Imaging showed significant deterioration in the basal ganglia changes and a CT chest showed mediastinal and hilar lymphadenopathy consistent with sarcoidosis. Lymph node biopsy showed granulomatous inflammation again consistent with sarcoidosis. She was treated with steroids and there was a dramatic improvement. Neurosarcoidosis is a rare association of an already fairly rare condition, affecting around 5% of people with sarcoidosis. Of these 5% the neurological symptoms are the first presentation of the sarcoidosis in around 50%. Whilst there are many presentations of neurosarcoidosis, most commonly cranial neuropathies or pituitary axis involvement, there is little in the literature describing neurosarcoidosis presenting with chorea.