Tuberculous meningitis is a rare and potentially fatal infectious disease. Delayed diagnosis and treatment will result in a poor neurologic outcome; however, early diagnosis is not always easy because of nonspecific signs and symptoms. We report a 10-month-old boy presenting vomiting and “not doing well”, finally diagnosed as having tuberculous meningitis. Brain CT on admission showed significant basilar meningeal enhancement as well as obstructive hydrocephalus and multiple ring-enhanced parenchymal lesions. Even though the clinical manifestations or laboratory test results were not specific, the neuroimaging findings led us to raise a high index of suspicion of tuberculous meningitis. Specific laboratory tests for Mycobacterium tuberculosis were promptly initiated, which aided in the immediate confirmation of the diagnosis. The characteristics of the neuroimaging findings of tuberculous meningitis have been well documented; however, not every pediatrician is familiar with interpretation of the imaging findings. The present case will help pediatricians to be aware of clues to the early diagnosis of tuberculous meningitis.
