Question

A patient involved in a road traffic accident presents with quadriparesis, sphincter disturbance, a sensory level up to the upper border of the sternum, and a respiratory rate of 35 per minute. The likely level of lesion is:

• A. C1-C2
• B. C4-C5
• C. T1-T2
• D. T3-T4

Hint:

Four weak limbs plus laboured breathing at 35 per minute means a lower cervical, not C1-C2, lesion.

Answer 1

The Correct Option is B

Step 1: Use the quadriparesis. Weakness of all four limbs means the cord injury is in the cervical region. A thoracic lesion (T1-T2 or T3-T4) would spare the arms and give only paraparesis, so the lower options are out.

Step 2: Use the sensory level. The upper border of the sternum corresponds roughly to the T2 dermatome at the manubrium, but the sensory level is set by the highest intact segment, and the cervical dermatomes (C4 over the upper chest near the clavicle) localise the lesion to the lower cervical cord rather than the upper thoracic spine. The combination of arm weakness with a high chest sensory level points to a lesion around C4 to C5.

Step 3: Use the breathing. The diaphragm is supplied by the phrenic nerve from C3, C4 and C5. A lesion at C4-C5 partially compromises diaphragmatic drive, so the patient is tachypnoeic at 35 per minute and is struggling to ventilate. A C1-C2 lesion would abolish the phrenic supply completely and cause apnoea or immediate respiratory arrest, not a fast spontaneous rate.

Step 4: Add sphincter disturbance. Loss of bowel and bladder control simply confirms a complete cord lesion above the sacral outflow, which is consistent with a high cervical injury.

Step 5: Quadriparesis plus a high chest sensory level plus laboured but present breathing all fit a lower cervical lesion. The answer is C4-C5 (option B).