Cerebral tuberculosis kills or disables a higher proportion of sufferers than any other form of tuberculosis, yet little is known about the pathogenesis. The seminal studies of Rich and McCordock, performed more than 70 years ago, demonstrated that the development of tuberculous meningitis requires two steps. First, bacteria travel in the blood from the lungs to the meninges where they form discrete foci of infection (Rich foci). Second, foci rupture and release bacteria into the subarachnoid space so heralding the onset of meningitis [1]. Our understanding of the pathogenesis of cerebral tuberculosis has advanced little since these studies.