The authors conducted this study to identify whether bacille Calmette-Guerin (BCG) vaccination leads to an altered spectrum of neuroimaging findings outcome in pediatric Patients with tuberculous meningitis. This retrospective study was conducted through chart review and review of computed tomography (CT) scans and magnetic resonance imaging (MRI) of Patients with confirmed central nervous system tuberculosis from the year 1992 to 2005, at a large tertiary care hospital in Karachi, Pakistan. A total of 108 pediatric Patients with tuberculous meningitis were included in the analysis. Of the 108 Patients, 63 (58.3%) were male and 45 (41.7%) had received bacille Calmette-Guerin vaccination. There was no difference in terms of severity of clinical presentation and outcome between vaccinated and unvaccinated group. There were no significant differences in CT or MRI findings between the 2 groups except for tuberculomas on MRI, which were significantly higher in the non-bacille Calmette-Guerin vaccinated group (52.2% vs 22.7%, P = .042). Bacille Calmette-Guerin vaccination appears to translate into less tuberculoma formation on MRI.