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Introduction and Importance: The neurologic symptoms that appear due to paraneoplastic syndrome may give manifestations of undiagnosed tumor, and give an opportunity for early detection and treatment of it. Case Presentation: Here the authors present a case of a 54-year-old woman who suffered from rapidly progressive muscle weakness, accompanied by right third cranial nerve palsy. Clinical Discussion: The nerve conduction study consistent with multiple mononeuropathy, and laboratories revealed undiagnosed diabetes mellitus but elevated erythrocyte sedimentation rate and the rapid progression prompted for additional investigations. Brain MRI, repetitive nerve stimulation, lumbar puncture, and paraneoplastic panel were all negative. Computed tomography scan with contrast for the abdomen showed a right renal mass consistent with renal cell carcinoma. The tumor was removed and steroids and intravenous immunoglobulin was started but without any clinical improvement because of the late presentation. Conclusion: Patients with renal cell carcinoma can present with paraneoplastic syndromes but multiple mononeuropathy are extremely rare. It is crucial to investigate for all possible causes of neuropathy and not attributing it to a new discovered diabetes in the presence of clinical and laboratory red flags such as rapid progression and elevated erythrocyte sedimentation rate.

Background: Cerebral venous thrombosis (CVT) is a relatively common disease. Risk factors for CVT include pregnancy, cancer, autoimmune diseases, and hypercoagulation. Acute and chronic meningitis are also considered predisposing conditions for CVT. Cases of CVT associated with tuberculous meningitis and miliary tuberculosis (TB) are rare in the medical literature, and here the authors report the first case report from Middle East. Case presentation: The authors present a 33-year-old female patient diagnosed initially with CVT to discover the presence of tuberculous meningitis and miliary TB. Clinical discussion: CVT is an urgent condition and the outcome is usually good when treated quickly. The mechanisms of TB causing thrombosis are endothelial injury, slow venous flow, and increased platelet aggregation. The clinical presentation of CVT can be confused and falsely attributed to TB Meningitis. Conclusion: Infectious causes of CVT should always be remembered, especially TB should be in mind in developing countries.