Tuberculous meningitis (TBM) occurs mainly in developing countries where tuberculosis (TB) is more common and the wider incidence of the human immunodeficiency virus (HIV) favors the onset of a great number of cases. However, TBM is also encountered in industrialized countries, particularly in recent years, as a consequence of the large immigration of infected people1 and the frequent use of biological agents that favor TB development.2,3 Children are among the subjects who most frequently suffer from TBM due to their relative inability to contain primary Mycobacterium tuberculosis infection in the lung.1,3 TBM is a devastating disease with about 30% mortality in the most severe forms; moreover, 50% of survivors have neurological sequelae despite apparently adequate administration of antibiotics.4,5 Early diagnosis and prompt treatment are crucial for reducing the risk of a negative evolution. However, especially in children, the best and most rapid way to diagnose the disease is controversial; the optimal choice, dose, and treatment duration of anti-tuberculosis drugs are not precisely defined, and the actual importance of adjunctive therapies with steroids and neurosurgery have not been adequately demonstrated. Consequently, the approach to pediatric TBM is frequently inadequate. This review is aimed at discussing