Tuberculosis is a global public health problem. In pediatric ages it represents between 3% and 40% of the total disea- se. In countries with high incidence, such as Ecuador, the presence of cases of childhood tuberculosis always indicates the circulation of Mycobacterium tuberculosis or contact with an untreated patient or undiagnosed. In our country there is a high percentage of underdiagnosis of childhood tuberculosis and a lower burden than expected, mainly in children under 5 years of age. Meningeal tuberculosis is the most serious form of presentation of infection by M. tuberculosis in pediatric age since it causes many deaths and disability. The diagnosis of tuberculous meningitis is achieved considering epidemiological criteria, laboratory studies in blood, cerebrospinal fluid, and neuroimaging. Early treatment improves the prognosis, but the problem lies in making an early diagnosis, since it has different forms of clinical presentation ranging from nonspecific symptoms to severe neurological involvement.