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. It can occur after damage to the central nervous system such as spinal cord injury. 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).
Neurogenic shock results from damage to the spinal cord above the level of the 6th thoracic vertebra. It is found in about half of people who suffer spinal cord injury within the first 24 hours, and the usually does not go away for one to three weeks.
- 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 is administered for slowed heart rate.
- 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".
- Newman, Mark F.; Fleisher, Lee A.; Fink, Mitchell P. (2008). Perioperative Medicine: Managing for Outcome. Elsevier Health Sciences. p. 348. ISBN 1-4160-2456-5.
- Holtz, Anders; Levi, Richard (6 July 2010). Spinal Cord Injury. Oxford University Press. p. 63–4. ISBN 978-0-19-970681-5.