Tuberculosis is a major public health problem. Pulmonary involvement is the most frequent, and central nervous system involvement in this infection remains rare but serious, as it exposes patients to high mortality and a significant risk of neurological sequelae. Diagnosing these manifestations remains difficult due to the challenging and dangerous diagnostic approach. The association of pulmonary and central nervous system involvement in tuberculosis is possible but rare. We describe a case of this rare situation where the radiological characteristics of the neurological involvement led to the investigation of respiratory tuberculosis in a 21-year-old man.