Despite great advances in immunology, microbiology, and drug development, tuberculosis (TB) remains among the great public health challenges. Due to obscure evolution and fatal outcome, tuberculous meningitis is a very critical disease. The particularities in evolution and treatment results was the research aim. It was performed a retrospective, descriptive, cohort type research on 46 patients with TB meningitis, for 2000-2018 years. The male/female ratio is 4.75/1; aged <40 years 21 (46%), 40-60 years 20 (43%), >60 years 5 (11%). 32 (70%) patients are from contact clusters, including 28 (60%) with >1 year contact at home or institutionalized. Associated risk factors were in 100% cases, among them underweight 13 (28%), unemployed 11 (24%), immigrants 9 (20%), poor living conditions 28 (61%), TB/HIV non TARV users 12 (26%). Were detected by active screening 2 (4%) patients and 44 (96%) by passive case finding with an acute onset of the disease. Meningitis was diagnosed as primary disease in 8 (17 %), or complication of an early known TB in 38 (83%). An intoxication syndrome 46 (100%), meningitic symptoms 28 (60%), a bronchopulmonary syndrome 41 (90%) represented the clinical manifestations. Pulmonary TB were 32 (70%), among them 22 (68%) infiltrative form, fibro-cavitary 6 (17%), disseminated 4 (15%) and 14 (30%) of patients had extrapulmonary TB. TB etiology meningitis was confirmed by CSF analysis, as criteria: serous cerebrospinal flui (CSF), pleocytosis, positive Pandi reaction, hypoglycorahia and from 2013 with GeneXpert. AFB smear-positive sputum 16 (40%), culture positive 24 (60%), 6 (13%) patients diagnosed with GeneXpert. 31 (68%) were treated according to the standart regimen for drug-susceptible TB and 15 (22%) for MDR TB. Study ended with fatal outcome 41 (89%), positive results in 5 (11%) cases. Tuberculous meningitis develops at an young age, influenced by social risk factors and at TB/HIV non TARV users. TB etiology of the disease is confirmed by „almost” pathognomonic changes in CSF.