Tuberculosis (TB) is an infectious disease commonly found in both developing and developed countries. Tuberculosis meningitis (TBM) is a serious central nervous system infection with a high mortality rate despite anti-TB drug treatment and is associated with HIV/AIDS. The diagnosis of TBM is difficult since the clinical aspects of the disease are similar to other central nervous system infections, examination for AFB in cerebrospinal fluid (CSF) stained with Ziehl-Neelsen is not sensitive and culture of Mycobacterium tuberculosis from CSF takes too long to influence initial therapy. Delayed diagnosis and treatment of TBM results in high mortality and disability. We report a Lao patient who had pulmonary TB in combination with TBM (confirmed by positive AFB in a sputum examination and a positive culture of Mycobacterium tuberculosis in the CSF) whose diagnosis and treatment were delayed resulting in serious nervous system sequelae and disability which may not be easily reversible. We discuss TBM diagnosis and use of simple clinical and laboratory features and suggest a low threshold for empirical treatment with anti-TB drug in case of suspected TBM.