Most deaths in tuberculous meningitis occur in the early part of the illness. We assessed the determinants of early deaths, occurring within 2 months of intensive therapy. We prospectively included consecutive newly diagnosed adults with HIV-negative tuberculous meningitis. Patients were given WHO-recommended antituberculosis treatment and were followed up for 9 months. We enrolled 152 patients. A total of 26 deaths were recorded during 2 months. The logistic regression analysis revealed that papilledema (P= 0.029, odds ratio (OR)= 4.8 [1.2–19.8]), increasing age (P= 0.001, OR= 1.07 [1.03–1.1]), stage-III disease (Glasgow coma scale score≤ 10; P= 0.01, OR= 4.2 [1.4–12.3]), and hydrocephalus (P= 0.003, OR= 8.4 [2.1–33.6]) were independently associated with death. In addition, cerebral infarcts (P= 0.012, OR= 5.6 [1.5–21.3]), paraparesis (P= 0.004, OR= 8.8 [2.02–38.1]), and age (P= 0.005, OR= 1.05 [1.02–1.09]) were associated with poor functional outcome. In conclusion, disease severity predicts early deaths in tuberculous meningitis.