To describe a rare case of tuberculous meningitis. A 50-year old female presented with 11 days of numbness on the left side and fatigue and a three-day headache. Magnetic resonance imaging (MRI) showed multiple lesions in the dorsal medulla and upper cervical spinal. After admission, she developed a long-term fever, cranial nerves palsy and showed little response to corticosteroid, antibacterial and antiviral therapy. She received a diagnostic anti-tuberculous therapy (ATT) despite that all examinations for tuberculosis were negative. After ATT lasting 16 days, she was recovered and was discharged from hospital with slight asthenia and hypoesthesia.