Tuberculous meningitis presenting with quadriparesis without meningeal signs a diagnostic dilemma

In common clinical practice, diagnosis of meningitis relies on presence of neck stiffness in alert, healthy adult patients, except infants, the elderly and the immunocompromised. In current era high index of suspicion for meningitis should always be in differential in young immunocompetent patients, who even do not exhibit signs of meningeal irritation.