In countries where tuberculosis is still very common, millions of patients are placed under Anti-tuberculous treatment, of which Isoniazid is a component. The unfortunate co-occurrence TB in end-stage renal disease patient influences the metabolism and excretion of isoniazid and increases the chances of adverse effects. We wish to present one such patient of ours on ATT who returned to our care with neurological symptoms. Both the disease of tuberculosis and its treatment are fraught with occurrence of neurological involvement and complications. Diligent neurological examination pointed towards cerebellar pathology, possibly posterior circulation stroke. Ensuing MRI brain exhibited possible features indicative of drug (Isoniazid) induced cerebellitis. Consumption of the other two drugs, metronidazole and cycloserine, was excluded. Blood and CSF examinations did not show any abnormality. INH induced cerebellitis being our most possible diagnosis, high dose pyridoxine (100mg/day) therapy was initiated. Withing a week there was significant neurological improvement, and he was eventually discharged with modified ATT. Learning from this experience we would suggest to consider cerebellitis in patients with neurological symptoms on Isoniazid therapy and institute high dose pyridoxine therapy as a preventive measure in such patients.