Objective To investigate the dynamic observation of cytology and biochemical markers in cerebrospinal fluid combined with the MRI in the diagnosis of tubercular meningitis (TBM). Methods The clinical data of 110 patients with TBM admitted to our hospital from January 2013 to January 2017 were retrospectively analyzed. All patients received the dynamic observation of cytology and biochemical markers in cerebrospinal fluid, head MRI, and symptomatic treatment. Results The intracranial pressure, white blood cell count, myelocyte count, lymphocyte count, monocyte level of the secondary examination were significantly lower than those in the initial examination (P<0.05). The levels of cerebrospinal fluid protein, glucose, and cerebrospinal fluid adenosine deaminase were lower than those of the initial examination, while the chloride level was higher in the secondary examination (P<0.05). Thickening meningeal lesions was found in 38 cases; Lesions located in basal cisterns and lateral fissure pools were found in 105 and 5 cases, respectively. 81 patients had multiple chestnut-like lesions. The lesions presented isointense signal in T1WI and hypointense signal in T2WI. The lesions with diameter >5mm had perifocal edema and had tiny nodular enhancement after contrast administration. The intracerebral tuberculous abscess with hypointense signal in T1WI and hyperintense signal in T2WI. The lesions had ring-like enhancement after contrast injection with obvious edema. For cerebral infarction, the lacunar infarcts with lesions were distributed in the basal ganglia region. The image of hydrocephalus showed a dilated ventricular system with the most pronounced lateral ventricles. 80.91%were cured, 19.09% were invalid including 3.64% died. Conclusion The intracranial pressure, white blood cell count, myelocyte count, lymphocyte count, cerebrospinal fluid protein, glucose, and cerebrospinal fluid adenosine deaminase levels are elevated in patients with tuberculous meningitis. MRI shows a chestnut-like lesion in the brain parenchyma and thickening meningeal, and tiny nodular enhancement after contrast administration.