Introduction: Central nervous system tuberculosis is a serious health problem worldwide and accounts for more than 7% of all cases of tuber- culosis especially in developing countries with high prevalence of tuber- culosis and also should be considered in high risk patients or in patient emigrated from regions with a high prevalence of tuberculosis. Tubercu- lous radiculomylitis is a complication of tuberculous meningitis which has been infrequently reported in medical literature. Case description: Case I: A 49-year-old previously healthy Filipino female with 5 days history of fever, back pain radiating to both legs fol- lowed by acute onset of lower limb weakness and urine retention one day prior to presentation. Physical examination revealed pyrexia, alert patient, no sign of meningeal irritation and lower limb power decrease (3/5) normal exam of upper limb. Investigation showed elevated WBC in Cerebral Spinal Fluid (60% lymphocyte). Positive PPD and positive quantiferon test. MRI showed extensive enhancement around nerve roots extending cranially to lower thoracic. Patient started on antituberculous treatment, steroid and physiotherapy. Six month post treatment did not show significant neuro- logical improvement, but fever respond after start of treatment. Case II: A 27-year-old healthy Filipino female, presented with history of fever, headache, neck and back pain with vomiting, three weeks prior to presentation and was treated as case of otitis media with two different antibiotic given during two primary health care visits. Presented with one day lower abdominal pain with urinary retention and body weakness. Phy- sical exam showed lethargic patient afebrile with spastic quadriparesis power of upper limb 4/5 and lower limb 3/5. Investigation showed cere- brospinal fluid, high WBC (90% lymphocyte), high CSF protein and low glu- cose. High serum ESR. MRI showed increase leptomeningeal enhancement of spinal cord extending to the pons. Patient also started on steroid and anti- tuberclous drugs. Patient made good clinical recovery and discharged. Results and conclusions: In patient with tuberculous meningitis, an early diagnosis and initiation of therapy plays a major role in preventing unnecessary morbidity and mortality. In several series, use of the steroid has been considered beneficial and should be given for secondary neurological complications, associated with tuberculous meningitis. Emergency clinician must be aware of unusual presentation of tuberculous meningitis and other different causes of lower limb weakness. Neuroimaging with MRI with and without contrast and lumber puncture is critical for diagnosis.