A 60 year-old white woman presented with sudden painless dysphagia, hoarseness and dysphonia. A diagnosis of sarcoidosis was made based on bilateral hilar lymphadenopathy, gallium uptake, elevated serum angiotensin-converting enzyme levels, as well as non-caseating granulomatous lymphadenitis in a prescalenic node. Symptoms were attributed to isolated vagus neuropathy, a rare form of presentation of neurosarcoidosis.