Background <p>Disseminated cryptococcosis is a rare and fatal disease involving the central nervous system (CNS) that often presents with severe clinical symptoms and a poor prognosis.</p> Objective <p>To describe the neuroimaging findings of disseminated cryptococcosis in children and investigate their correlation with patients’ prognosis.</p> Materials and methods <p>The information of hospitalized patients with disseminated cryptococcosis was collected between January 2012 and December 2023. The study comprehensively evaluated clinical manifestations, laboratory tests, imaging findings, and long-term outcomes.</p> Results <p>Forty cases of disseminated cryptococcosis were identified; headache was more common in patients with CNS involvement than in those without (<i>P</i> &lt; 0.05). The most commonly affected organs were the lungs (<i>n</i> = 38; 92.5%), lymph nodes (<i>n</i> = 30; 75.0%), and CNS (<i>n</i> = 23; 57.5%). Among the 19 patients with CNS involvement, 11 (57.9%) had parenchymal lesions, and three (15.8%) showed restricted diffusion. Seven patients (50.0%) showed parenchymal enhancing lesions, and six patients (42.9%) showed leptomeningeal enhancement. Seizures (<i>P</i> = 0.022), parenchymal findings (<i>P</i> = 0.036), and lesions with enhancement (<i>P</i> = 0.019) were associated with poor outcomes, whereas lymph node involvement (<i>P</i> = 0.017) was associated with good outcomes.</p> Conclusion <p>Neuroimaging manifestations of disseminated cryptococcosis with CNS involvement frequently include brain parenchymal lesions. Furthermore, patients presenting with brain parenchymal lesions or seizures often have poor outcomes; therefore, early detection and intervention are imperative to improve patient prognosis.</p> Graphical Abstract <p></p>