A 53-year-old man who presented with a fever, headache, and a left leg disturbance was admitted to our hospital. A diagnosis of miliary tuberculosis and tuberculous meningitis was made according to the findings of a chest CT scan, brain MRI, cerebrospinal fluid test, and the bacterial culture results of each specimen. Antituberculous therapy (HREZ) was started, and thereafter his symptoms and chest CT images gradually improved. However, on day 33 he had a convulsion. Brain CT and gadolinium-enhanced MRI revealed hydrocephalus and abnormally enhanced areas on the meninges at the base of the brain. He was subsequently diagnosed to have a paradoxical reaction to the tuberculous meningitis because the pulmonary lesions of miliary tuberculosis were successfully improving, and no evidence of any recurrence of tuberculous meningitis was observed. Steroid therapy and ventricular drainage was thus started, and his symptoms thereafter gradually improved. However, on day 75 he experienced a disturbance of consciousness and repeated hydrocephalus. Because brain MRI showed the same abnormal findings as those seen after the first paradoxical reaction, a second paradoxical reaction was thus diagnosed.