This chapter reviews the current neuroimaging literature regarding disorders of arousal and parasomnias, particularly non-rapid eye movement (NREM) parasomnias. During REM sleep the patient exhibited REM behavior disorder (RBD) with mumbling, complex hand movements, and arm/leg jerks. A repeat magnetic resonance imaging (MRI) showed persistent increased T2 weighted image (WI) hyper intense/T1 WI hypo intense lesions in the right mesencephalic/ pontine tegmentum and the right medulla. MRI of the head revealed a T2 WI hyper intense lesion at the pontomesencephalic lesion presumed to be neurosarcoidosis. Imaging modalities when used in combination with clinical electrophysiology (e.g. EEG and PSG) provide better understanding into both structure and function of electrophysiologically verified parasomnias. Future studies combining both electrophysiology and multiple neuroimaging modalities may help in both the assessment of sleep-related dissociative disorders and the development of new treatment modalities.