[Tuberculous meningitis]

The incidence of tuberculosis has been increasing since 1985. Favourable host factors associated with non specific neurologic abnormalities must lead to the hypothesis of a meningeal tuberculosis. Blood analysis and radiological findings rarely contribute to the diagnosis. The diagnosis is established when tubercle bacilli are identified in the cerebral-spinal-fluid, sometimes immediately but most often after 4 to 6 week culture. New faster methodes are being developed, but they are not yet routinely available. The treatment must be started before the identification of the tubercle bacilli. Usually, for immunocompetent patient, short-course treatment is chosen, consisting of an initial 2-month intensive treatment (rifampycin, isoniazid, and pyrazinamide) followed by a 4-month maintenance therapy with isoniadid and rifampicin, ethambutol should be included systematically during the first 16 weeks in prevention of isoniazid resistance.