Headache and visual disturbance

An 1 -year-old boy presented with enteric fever (titres for Salmonella typhi positive as TH 640 andTO 320). He was prescribed pefloxacin 200 mg 12 hourly for 14 days. After regression offever in five days, he complained ofan occipitonuchal headache ofincreasing severity with vomiting and diplopia. No H/O ear discharge, visual symptoms or seizures. Clinical examination revealed an alert young boy with normal vital signs. Bilateral papilloedema was observed, with left lateral rectus paralysis. There were no other focal neurologic deficits. Visual acuity was normal with bilateral concentric constriction of visual fields and enlargement of blind spots. Electroencephalogram (EEG) showed diffuse theta to delta slowing. A computed tomography (CT) scan ofthe head was normal. Spinal tap showed an opening pressure of 300 mm cerebrospinal fluid (CSF) with normal cytology, sugar and proteins. Pefloxacin was withdrawn and the patient started on acetazolamide (250 mg eight hourly). He was symptom free in two weeks with regression of papilloedema in eight weeks.