A gentleman in his early 50's with past medical history significant for biopsy confirmed pulmonary sarcoidosis presented with acute onset confusion, gait disturbance and bowel/urinary incontinence. Brain imaging was consistent with normal pressure hydrocephalus and CSF studies supported the suspicion of neurosarcoidosis. He received treatment with a prolonged course of steroids with good effect. We discuss a rare case of normal pressure hydrocephalus as a presenting feature of neurosarcoidosis and the rationale of starting empiric treatment for probable diagnosis of the same.