Cryptococcal infection is a not uncommon infectious disease of the central nervous system. Unlike the large number of cryptococcal meningitis combined with AIDS abroad, cryptococcal meningitis in China is often associated with invasive treatment and indiscriminate use of immunosuppressive drugs, so it is often difficult to achieve effective treatment results by copying Western experience. However, due to its low relative incidence, most primary care physicians have difficulty accumulating enough experience and often lack knowledge of the disease, thus the current situation of difficult diagnosis and poor treatment results exists. The reasons for this are many, and the following is an analysis of the current situation of cryptococcal meningitis in terms of both diagnosis and treatment: Diagnosis Cryptococcal meningitis cannot be clearly diagnosed by simple questioning, physical examination and cranial MRI examination because of the lack of specificity in symptoms, signs and imaging examinations. Cerebrospinal fluid ink staining is currently the most commonly used clinical method for the diagnosis of cryptococcal meningitis, with high specificity, but because the method of cerebrospinal fluid pictures is often taken, cryptococci are not enriched, thus affecting the sensitivity of the test. Instead, the detection of cryptococci can be significantly improved by using MGG and Alisin blue staining after centrifugation of cerebrospinal fluid slides. However, so far, the development of cerebrospinal fluid cytology in China is not widespread, and the units that have developed cerebrospinal fluid cytology are not all familiar with the morphology of cryptococci after MGG and Alisin blue staining, which affects the diagnosis of cryptococcal meningitis. Treatment The combination of amphotericin B and 5-fluorocytosine is the antifungal treatment of choice for cryptococcal meningitis, and this classic treatment has led most neurologists to feel that there is little variation in the treatment of cryptococcal meningitis, making it difficult to show differences in the level of treatment. However, in fact, the current treatment of cryptococcal meningitis varies greatly. Sometimes, multiple ink stains reveal that no cryptococcus is found, but after stopping the drug, cryptococcal meningitis is found to recur, while in other cases, patients never review their cerebrospinal fluid cytology and use antifungal drugs for a long time, eventually causing liver and kidney damage. In addition, what puzzles neurologists is that in some patients, while the cryptococcal count continues to decline after antifungal treatment, the symptoms do not ease but worsen, and patients even go blind. In some cases, this is caused by immune reconstitution syndrome, i.e., as the cryptococci are cleared, the body’s suppressed immunity is restored, at which time the restored immunity sometimes produces an attack against itself, a condition called immune reconstitution inflammatory response. This condition is called immune reconstitution inflammatory response syndrome. Because there are so many variables in the treatment of cryptococcal meningitis, accurate assessment of the patient’s cerebrospinal fluid cryptococcal load and the patient’s immune status is critical to effective treatment. Therefore, all neurologists should be advised to raise awareness of the diagnosis and treatment of cryptococcal meningitis. In turn, patients should choose a qualified neurologist for formal treatment.