**4. Diagnosis of tuberculous meningitis**

The diagnosis of tuberculous meningitis is often a real challenge for the clinician, based in some cases on the clinical aspects and the changes found in the CSF, without bacteriological confirmation. The insidious onset with persistent symptoms for more than 6 days, the presence of neurological manifestations represented by cranial nerve paralysis or peripheral paralysis and the presence of a moderate inflammatory reaction in the CSF are elements that are suggestive for the diagnosis of TBM.

In TBM, the following changes in the cerebrospinal fluid are characteristic:

