Cryptococcus neoformans variety gattii (C. gattii) causes infection in predominantly immunocompetent individuals. The majority of cases present with headache due to meningitis and its natural history normally follows an indolent course. We report a fatal case of fulminant cryptococcaemia culminating in severe intracranial hypertension due to C. gattii. Such cases of fulminant disease are rare and highlight a number of important therapeutic and diagnostic considerations. We discuss the atypical nature of this patient's illness, the major complications of C. gattii meningitis and the role of computed tomography (CT) in preventing serious sequelae from lumbar puncture. The management of intracranial hypertension (ICH) in critically ill patients is also reviewed.