Objective To explore the diagnostic value of fever, blood sodium combined with neutrophil prcentage in tuberculous meningitis (TBM) secondary to pulmonary tuberculosis(PTB). Methods Clinical data of PTB patients who were admitted in a hospital from October 2015 to October 2018 were collected, 146 patients with TBM secondary to PTB were selected as study group, 584 patients of PTB patients without secondary TBM were as control group according to the proportion of 1:4 of admission time, diagnostic efficiency of blood sodium, neutrophil percentage, clinical fever symptom and their combination in TBM secondary to PTB were compared, area under the curve (AUC) was calculated, and critical point was determined. Results The critical points of blood sodium and neutrophil prcentage for the diagnosis of TBM secondary to PTB were 135.30mmol/L and 73.40% respectively. The AUC (95% CI) of fever, blood sodium, neutrophil percentage and their combination in diagnosis for TBM secondary to PTB were 0.732 (0.688-0.776), 0.768 (0.719-0.818), 0.727 (0.679-0.776) and 0.845 (0.807-0.882) respectively, with statistical significance (all P<0.05); sensitivity were 80.82%, 56.85%, 65.07% and 63.70% respectively, specificity were 65.58%, 87.50%, 73.46% and 89.38% respectively, there was no significant difference in AUC among the three, diagnostic efficacy of three combination was higher. Conclusion Fever, blood sodium<135.30 mmol/L or neutrophil percentage>73.40% have diagnostic significance for TBM secondary to PTB, there was no difference among the three, but the combination of the three has higher diagnostic value for TBM secondary to PTB.