Cervical spine MRI of a patient with SCI: C4 fracture and dislocation, spinal cord compression
|Classification and external resources|
Neurogenic shock is a distributive type of shock resulting in low blood pressure, occasionally with a slowed heart rate, that is attributed to the disruption of the autonomic pathways within the spinal cord. Low blood pressure occurs due to decreased systemic vascular resistance resulting in pooling of blood within the extremities lacking sympathetic tone. The slowed heart rate results from unopposed vagal activity and has been found to be exacerbated by hypoxia and endobronchial suction. Neurogenic shock can be a potentially devastating complication, leading to organ dysfunction and death if not promptly recognized and treated. It is not to be confused with spinal shock, which is not circulatory in nature.
Neurogenic shock can result from severe central nervous system damage (brain injury, cervical or high thoracic spinal cord). In more simple terms: the trauma causes a sudden loss of background sympathetic stimulation to the blood vessels. This causes them to relax (vasodilation) resulting in a sudden decrease in blood pressure (secondary to a decrease in peripheral vascular resistance)
- Dopamine (Intropin) is often used either alone or in combination with other inotropic agents.
- Vasopressin (antidiuretic hormone [ADH])
- Certain vasopressors (ephedrine, norepinephrine). Phenylephrine may be used as a first line treatment, or secondarily in people who do not respond adequately to dopamine.
- Atropine (administer if slowed heart rate is severe.)
- J.M. Piepmeyer, K.B. Lehmann and J.G. Lane, Cardiovascular instability following acute cervical spine trauma, Cent Nerv Syst Trauma 2 (1985), pp. 153–159.
- 4. Guly HR, Bouamra O, Lecky FE. The incidence of neurogenic shock in patients with isolated spinal cord injury in the emergency department. Resuscitation (2008) 76, 57-62
- "Dorlands Medical Dictionary:neurogenic shock".