Tuberculosis is becoming an increasingly troublesome public health problem mostly because of incomplete therapy of existing cases giving rise to multi-drug resistant strains and because of increase in immunodeficiency states from various causes. The disease affects preferentially economically underprivileged individuals. In this paper, we review the pathogenesis and radiological findings of meningo-encephalic tuberculosis. Imaging manifestations are very pleomorphic and can mimic parenchymal cerebral mass lesions or meningeal processes of different nature. Although imaging findings are generally non-specific, modern imaging plays a key role in the diagnosis. A high index of suspicion in the appropriate clinical and laboratorial setting may promote rapid diagnosis and institution of therapeutic measures that avoid death or serious neurological consequences.