TB meningitis usually takes long time -may be few weeks to respond to anti TB drugs. Usually it is treated only with medications, rarely surgical treatment is required ( mostly when they develop what is called hydocephalus), many will improve with drugs if proper dosage of medication is given for sufficient duration

Hello
Welcome to HealthcareMagic.Tuberculous meningitis always puts a doctor into a diagnostic dilemma as it presents as any other meningoencephelitis which also includes a partially treated meningitis, cerebral abscess or even viral infections.He should be checked for Syphilis and HIV preferably.There are certain things which help to some extent, in confirming the diagnosis of TBM like certain eye changes(optic atrophy), certain abnormal movements seen at times, weakness of some part of the body.A brain biopsy also may be done but then again it has its risks too. A Dot-iba(dot immunobinding assay) can be done , which may differenciate a TB meningitis from a partially treated pyogenic meningitis.And above all its very important to know that the duration needed for antimicrobials for TB meningitis is very unclear.The antimicrobials prescribed best for TBM are Isoniazid, Pyrazinamide, Rifampicin and Streptomycin, which am sure your doctor must have put your brother already on.And they must have been prescribed for 6-9 months. They might even go upto 24 months, no specific guidelines. A poor outcome is seen when there is extensive tuberculous damage leading to a lack of cerebral perfusion, that is like a stroke( where blood circulation is compromised).Hence medications to improve cerebral circulation should also be given preferably.And finally, a surgical intervention is warrantied, only when vital structures are compromised, which is why your brother is still on conservative treatment only.So,have patience, let the complete course of medications be over, as prescribed by your physician. I hope I could satisfy you with my answer. Please keep me poted.Wish your brother sooner recovery. Thankyou