Background: Tuberculous meningitis (TBM) and viral meningitis (VM) represent significant challenges in clinical practice owing to their overlapping initial symptoms and varied disease courses. This retrospective study aimed to identify key clinical and biochemical parameters distinguishing between TBM and VM, and evaluate the efficacy of a rapid clinical scoring system in their differentiation. Methods: Data from 38 patients admitted to Chettinad Hospital and Research Institute between 2018 and 2023 with confirmed diagnoses of TBM or VM were retrospectively analyzed. Clinical parameters, including duration of symptoms before admission, neurological staging, and cerebrospinal fluid (CSF) analysis (CSF-to blood glucose ratio and CSF protein levels) were documented. A rapid clinical scoring system incorporating these parameters was applied to assess the diagnostic accuracy. Results: Of 38 patients, 31 (81.57%) had TBM and 7 (18.43%) had VM. Patients with TBM demonstrated a longer duration of symptoms before admission (>5 days), worsening neurological staging, a CSF-to-blood glucose ratio <0.5, and elevated CSF protein levels (>100 mg/dL). The rapid clinical scoring system showed high sensitivity (93.1%) and specificity (91.67%) in differentiating between TBM and VM, with a positive predictive value of 98.18%, a negative predictive value of 73.33%, and an area under the ROC curve of 0.966.