Tuberculosis meningitis (TBM) is a serious public health problem in developing countries as it leads to significant mortality and residual neurological squeal. The estimated mortality due to TBM in Asia is 1.5 per 100,000 populations. Objectives: To determine the frequency of hydrocephalus in cases of TBM. Methodology: This was a cross sectional study conducted during July 2016 to December 2016 conducted at Department of Medicine Services Hospital, Lahore. The detailed demographic data was collected. Cases fulfilling the criteria of TBM underwent CT scan of brain (with IV contrast) for confirmation of TBM at the Department of Radiology, Sheikh Zayed hospital Rahim Yar Khan. Results: In this study there were 93 cases, out of which 54 were males and 39 females with mean of 34.13±9.45 years. Hydrocephalus was seen in 61 (65.59%) out of 93 cases of TBM. It was seen significantly higher in male group where it caused it in 40 out of 54 males (74.1%) with p value of 0.04 (table 1). In context of age groups with respect to hydrocephalus it was seen maximum in patients with age group of 31 to 40 years affecting 12 (80%) out of 15 of its respective group. It was followed by 41 to 50 years affecting 28 (68.3%) of 41 cases, though this difference was not found statistically significant with p value of 0.24. Hydrocephalus was observed maximum in stage I of TBM where it affected 4 out of 5 cases followed by stage II with 36 of 52 cases and then stage III with 21 of 36 patients. This difference was also not significant with p= 0.44. Conclusion: Hydrocephalus is an important and deadly complication of tuberculous meningitis and is noted in every 2 (65.59%) out of 3 cases. There is significant association of male gender with hydrocephalus.