A patient involved in a road traffic accident presents with quadriparesis, sphincter disturbance, sensory level up to the upper border of sternum and respiratory rate of 35/minute. The likely level of lesion is
**Core Concept**
The patient's presentation suggests a spinal cord injury with quadriparesis, indicating bilateral involvement of the upper and lower motor neurons. The sensory level up to the upper border of the sternum and sphincter disturbance suggest a high-level spinal cord injury.
**Why the Correct Answer is Right**
The patient's symptoms are consistent with a high cervical spinal cord injury, likely at the C4 or C5 level. The quadriparesis and respiratory rate of 35/minute suggest diaphragmatic weakness, which is a common finding in high cervical spinal cord injuries. The sensory level up to the upper border of the sternum is consistent with a high cervical lesion, as the spinal cord segments at this level correspond to the dermatomes of the upper chest.
**Why Each Wrong Option is Incorrect**
* **Option A:** This option is incorrect because it does not account for the patient's respiratory symptoms. A thoracic spinal cord injury would not typically cause diaphragmatic weakness.
* **Option B:** This option is incorrect because it does not explain the patient's quadriparesis. A lumbar spinal cord injury would not cause bilateral upper and lower motor neuron signs.
* **Option C:** This option is incorrect because it does not account for the patient's sensory level. A high thoracic spinal cord injury would not typically cause a sensory level up to the upper border of the sternum.
**Clinical Pearl / High-Yield Fact**
In spinal cord injuries, the level of lesion can often be estimated by the sensory level, which corresponds to the dermatomes of the spinal cord. The dermatomes can be remembered using the "six dermatomes" mnemonic: C4 (neck), C5 (shoulder), C6 (elbow), C7 (middle finger), T4 (upper chest), and T10 (lower abdomen).
**Correct Answer:** C. Cervical spinal cord injury at C4 or C5 level.