A patient involved in a road traffic accident presents with quadriparesis, sphincter disturbance, sensory level up to the upper border of sternum and a respiratory rate of 35/minute. The likely level of lesion is –
**Core Concept**
The clinical presentation described in the question suggests a spinal cord injury, which can be localized based on the level of neurological deficits. The involvement of quadriparesis, sphincter disturbance, and a sensory level up to the upper border of the sternum indicates a cervical 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 level of C4 or C5. This is because the sensory level up to the upper border of the sternum corresponds to the dermatome of C4. The presence of quadriparesis and sphincter disturbance also suggests a high-level cord injury. The respiratory rate of 35/minute may indicate respiratory muscle weakness, which is common in high cervical spinal cord injuries.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because a thoracic spinal cord injury would not typically cause quadriparesis or a sensory level up to the upper border of the sternum.
**Option B:** This option is incorrect because a lumbar spinal cord injury would not cause sensory loss up to the upper border of the sternum or quadriparesis.
**Option C:** This option is incorrect because a sacral spinal cord injury would not cause the range of symptoms described, including quadriparesis and sensory loss up to the upper border of the sternum.
**Clinical Pearl / High-Yield Fact**
The Brown-Sequard syndrome is a classic presentation of a spinal cord injury, characterized by ipsilateral weakness and loss of proprioception, with contralateral loss of pain and temperature sensation. This syndrome is typically seen in cervical spinal cord injuries.
**Correct Answer: C.**