Even with antituberculosis therapy, tuberculous meningitis causes death or severe disability in more than half of affected adults. In this double-blind, placebo-controlled trial, conducted in Vietnam, dexamethasone treatment was associated with a reduced risk of death as compared with placebo (31.8 percent vs. 41.3 percent). Dexamethasone treatment was associated with a reduced risk of death but the proportion of survivors with severe disability is not reduced. Tuberculous meningitis is the severest form of infection with Mycobacterium tuberculosis, causing death or severe neurologic deficits in more than half of those affected in spite of antituberculosis chemotherapy. 1 , 2 Attenuation of the inflammatory response in bacterial and mycobacterial meningitis may improve outcome by reducing the likelihood or severity of neurologic complications. Early studies suggested that corticosteroids reduced cerebrospinal fluid inflammation and time to recovery in patients with tuberculous meningitis, but the studies were too small to confirm any effect on survival. 3 – 7 Concern remained that corticosteroids might reduce the case fatality rate but increase the number of disabled patients. . . .