Clinical diagnosis often focuses on identifying the single cause of a patient’s symptoms but it is becoming increasingly recognized that a subset of patients exist where 2 pathological entities coexist. These patients present a particular diagnostic challenge because the first “positive” diagnostic test is not the definitive stopping point in their evaluation. Here, we present the case of a 47-year-old woman with multiple cranial neuropathies and a polyradiculopathy. A significant pleocytosis in the cerebrospinal fluid sparked a broad evaluation which revealed pathologic evidence of sarcoidosis and molecular evidence of neurofascin (NF)-155 and NF-140 antibodies. The pathogenic contribution of these 2 pathologic entities, or interaction, to this patient’s case is not clear. Nevertheless, the patient responded robustly to steroids and symptoms significantly improved. This case is a demonstration of the balance between Occam’s razor and Hickam’s dictum in clinical practice.

Original languageEnglish
Pages (from-to)118-120
Number of pages3
Issue number2
StatePublished - Apr 1 2020


  • cranial neuropathy
  • neurofascin
  • polyradiculopathy
  • sarcoid


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