A 50-Year-old diabetic patient presented with orbital pain, swelling and chemosis along with fever. He has been treated for an infection in the orbit presumably orbital cellulitis 10 days ago. O/E: – 3rd, 4th and 6th cranial nerves involvement seen Trigeminal neuropathy affecting V1 and V2 divisions The neuropathy was observed initially on left side but later right side was also affected. CT venogram of the patient Which vein is most likely responsible for the above condition: –
Correct Answer: Superior ophthalmic vein
Description: This is a case of cavernous sinus thrombosis post orbital cellulitis meaning the septic thrombi came the superior ophthalmic vein. It is a life-threatening condition. Presents as orbital/facial pain Orbital swelling and chemosis is seen. 3rd, 4th, 5th and 6th cranial nerves are affected Occurs secondary to infection from orbital cellulitis and sinusitis CT venogram shows distended cavernous sinus with a non-fat density filling defect-likely thrombus. Pathways of spread of infection to cavernous sinus. FACIAL VEIN - ANGULAR VEIN - SUPERIOR OPTHALMIC VEIN - CAVERNOUS SINUS DEEP FACIAL VEIN - PTERYGOID PLEXUS - CAVERNOUS SINUS
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