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: –

**Core Concept:** Trigeminal neuralgia is a common neurological disorder characterized by episodes of severe facial pain, typically triggered by facial movements. It can be caused by various factors, including compression or irritation of the trigeminal nerve. Orbital cellulitis is an infection of the soft tissues surrounding the orbit, often leading to inflammation and subsequent neurological symptoms. CT venogram is a type of CT scan that highlights the veins and venous sinuses, providing detailed information about the venous system.

**Why the Correct Answer is Right:** In this case, the patient presents with symptoms of trigeminal neuralgia, including facial pain, swelling, and neuropathy affecting both sides of the face. The CT venogram is performed to investigate the underlying cause of these symptoms, specifically to identify the affected vein.

**Why Each Wrong Option is Incorrect:**

A. **Superior orbital vein (SOV)**: This vein is too high in the orbit and does not typically cause trigeminal neuralgia.

B. **Inferior orbital vein (IOV)**: Similar to SOV, IOV is not responsible for causing trigeminal neuralgia.

C. **Supine position**: The patient's symptoms and examination findings suggest an orbital pathology, not a positional issue.

D. **Left internal carotid artery**: Although the patient has bilateral symptoms, this option is incorrect as internal carotid arteries are part of the arterial system, not the venous system. The correct answer focuses on the venous system, not arterial system.

**Clinical Pearl:** In cases of facial neuropathies, a thorough clinical evaluation and imaging studies like CT venogram are essential to identify the affected vein and guide appropriate treatment. A detailed understanding of the venous anatomy of the orbit is crucial in making an accurate diagnosis.

✓ Correct Answer: B. Superior ophthalmic vein