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Tuberculous meningitis (TBM) is still a crippling disease with a high degree of morbidity and mortality. One of the most severe complications of TBM is stroke resulting from vascular involvement. In HIV-infected individuals with TBM, the immune response to the tuberculous bacilli is altered; therefore, pathological features are very different from those seen in patients with relatively normal cell-mediated immunity (CMI). The brains of such individuals showed minimal inflammatory response with parenchymal infarcts and vasculitis, not only in the basal ganglia but in the cortical parenchyma as well. Computed tomography (CT) or magnetic resonance imaging (MRI) of the head may reveal intense basal enhancement after intravenous contrast administration, communicating or noncommunicating hydrocephalus, cerebral infarcts, parenchymatous tuberculomas, or a combination of two or more of these features. Besides chemotherapy, patients of TBM with vasculitis and infarcts should be given corticosteroids in a dose of 1 mg/kg/day, tapering this over 4-6 weeks.