The high case fatality rate in CCM, predicted by the WHO to be between 35% and 65% in sub-Saharan Africa prompted the recommendation that patients with a CD4 less than 100 have early screening for the disease.14 LP and CSF analysis remain the key diagnostic test for CCM but, if LP needs to be delayed, an urgent serum cryptococcal latex antigen test (CLAT) must be performed on all patients suspected of CCM.15 Patients with CCM often present with a severe headache and an isolated sixth nerve palsy. This evidence concerns the gene CD4 and cerebral cavernous malformation.