Meningitis caused by Mycobacterium tuberculosis remains an important cause of morbidity and mortality worldwide, and presents specific challenges in terms of diagnosis and management. The nonspecific clinical presentation of tuberculous meningitis has led researchers to develop newer biochemical and molecular methods of making the diagnosis. Several of these methods have excellent sensitivity and specificity, although are not yet available for clinical use. Successful therapy for tuberculous meningitis requires a combination of antimicrobial agents, with vigilance towards the possibility of disease caused by resistant organisms. Adjunctive corticosteroids also have a role in treating this potentially devastating infection. With proper therapy, morbidity and mortality can be minimized in patients with tuberculous meningitis.