To define the clinical and public health aspects of tuberculous meningitis, we conducted a 10-year retrospective review of patients with central nervous system (CNS) tuberculosis, investigated health department records of contact investigations involving our patients, and assessed prospective follow-up of patients. Thirty-one cases of CNS tuberculosis (8.6% of all pediatric patients with tuberculosis) were reviewed. Three patients had tuberculomas, 23 had meningitis, and five had both. Cranial nerve involvement, basilar meningitis, and hydrocephalus were common clinical and radiographic findings. Sixty-eight percent had been examined by a physician in the preceding month, and 13% had been hospitalized. Symptoms related to tuberculosis averaged 17 days before admission. For 15 patients (47%) there was no initial family history of tuberculosis, but an adult with tuberculosis was discovered after the child's symptoms became evident. Tuberculosis had been diagnosed in an adult in close contact with nine of the patients (38%) before the child became ill. Eight of these adult source cases already had been reported to the health department, and more rapid examination of contacts may have prevented meningeal tuberculosis in the child. The diagnosis of CNS tuberculosis should be considered in all children with neurologic signs and symptoms of, and risk factors for, tuberculosis.