Occasionally, symptoms and signs of a radiculomyelopathy predominate, due to spinal cord involvement. Patients may have radicular pain, stiffness or spasticity, limb weakness, sphincter disturbances, loss of sensation and weakness. Based on the polysaccharide wall serology, use of nutrients and DNA sequence, it is subclassified into C neoformans neoformans and C neoformans gatii. CSF may yield normal routine results in one fourth of patients, and be minimally abnormal in as many as one half, thus it is crucial to identify the organism via India ink and serology. Opening pressure is elevated to above 200 mm H2O in approximately two thirds of patients, so this is an important test.
Appearance can be clear or turbid.
Titers may reach dilutions of 1000. False negatives can occur. False positives occur with positive and due to test kit variations. But a positive titer is sufficient to initiate therapy, while cultures are pending, in the appropriate clinical setting. Commonly in patients with increased intracranial pressure the ventricles are actually small.