Abstract: Objective To investigate the differential diagnosis of cryptococcal meningitis(CM) and tuberculous meningitis(TBM).  Methods  We analyzed retrospectively the clinical data of clinical manifestation, cerebrospinal fluid(CSF) and head CT or MRI in 19 cases with cryptococcal meningitis and in 50 cases with tuberculous meningitis.  Results There were significant differences in delayed diagnostic time, complications, cranial nerve damage, intracranial pressure and glucose value of CSF, positive rate of polymerase chain reaction for TB(PCR-TB）, positive rate of lipoarabinomannan antibody(LAM-Ab) in serum and CSF, erythrocyte sedimentation rate(ESR), the detect rate of abnormal imaging in head CT or MRI between TBM and CM. However, there were not significant differences in clinical manifestation, white cell count in CSF, protein value, chloride value, adenosine deaminase(ADA) value, head CT or MRI imaging between TBM and CM.  Conclusions The clinical characteristics of CM are atypical. It is difficult to be differentiated with TBM and be misdiagnosed easily. Multiple markers combination is useful to diagnose CM earlier.

Key words: meningitis, cryptococcus, tuberculosis, meningeal/diagnosis, diagnosis,differentiol