Disseminated tuberculosis to the brain and spine 
may present before typical tuberculosis systemic symptoms 
manifest. We present a case where a patient presented with 
progressive paraplegia and change in mental status. Imaging 
revealed a thoracic tuberculoma and disseminated disease to 
the brain. Conservative treatment was initiated with 
improvement in sensorium. Due to lack of surgical success in 
the literature for tuberculoma resection and 14 day delay in 
presentation to our institution from onset of paraplegia 
surgical intervention was not considered for this patient.