Nodding syndrome is a neurological condition of unknown cause that affects children in East Africa. The condition is characterized by cognitive impairment, stunted growth, seizures and stereotypical nodding of the head, and can lead to progressive neurological deterioration and death. Now, a new immunohistochemistry study has identified tau neuronal neurofibrillary tangles, neuropil threads and dot-like lesions in post-mortem brains of individuals with nodding syndrome. The pathology was found to preferentially affect the frontal and temporal lobes, most prominently on the crests of gyri. The findings shed new light on the underlying mechanisms of this understudied epidemic disorder and open new potential lines of enquiry into the elusive cause of the disease.