After a spinal cord injury, you may experience neurogenic shock. It occurs in those with injury levels T6 or higher.
Neurogenic shock mostly affects your circulatory system, but if left untreated, it can lead to the failure of other major organ systems and be fatal.
We’ll go over everything you need to know about neurogenic shock so that you’re well-informed of all its symptoms and treatments.
What is Neurogenic Shock?
Neurogenic shock is when a disruption to the central nervous system (like a spinal cord injury) causes loss of sympathetic tone.
Sympathetic tone is what keeps your blood vessels toned and tight. It helps push blood forward from the heart to your organs.
Loss of sympathetic tone will cause your blood vessels to expand and loosen in a process called vasodilation.
This means that there’s no pressure to push oxygen-rich blood to your organs, which leads to not enough oxygen circulating through your body.
Your body needs oxygen to convert nutrients into energy to carry out everyday autonomic functions. Without it, your major organ systems will start to shut down.
Loss of sympathetic tone will also cause blood to pool in your veins. Instead of going back to the heart, the blood collects in your extremities.
It’s a harmful cycle where less and less blood circulates throughout the body. This causes your blood pressure to drastically drop.
Symptoms of Neurogenic Shock
Your heart needs to pump a certain amount of blood throughout the body to keep it functioning normally.
Neurogenic shock symptoms include:
- hypotension: Decreased blood pressure due to lack of sympathetic tone in your blood vessels.
- bradycardia: Slow heart rate because your heart cannot pump enough oxygen-rich blood to your organs.
- organ dysfunction: Lack of oxygen will cause your organs to start shutting down.
- warm skin: Pooling of blood in your veins will cause warm, dry skin.
In order to avoid permanent tissue damage, you should address these symptoms immediately.
Treatment for Neurogenic Shock
Treatment goals for neurogenic shock are to restore heart rate and blood pressure to normal levels to ensure that your organs have enough oxygen supply.
Neurogenic shock treatments include:
- IV fluids
IV fluids are the primary treatment for low blood pressure. They replenish fluid levels in the veins to help stabilize blood pressure.
If IV fluids prove ineffective, vasopressors help tighten blood vessels and increase blood pressure. The most common vasopressors to treat neurogenic shock are norepinephrine, phenylephrine, and dopamine.
If your heart rate is low, your doctor will likely prescribe atropine. It helps activate the fight or flight response in your body to increase heart rate.
By focusing on restoring heart rate and blood pressure to normal levels, all other symptoms of neurogenic shock should start to get resolved.
Blood will no longer pool in your veins if your blood vessels tighten and an increased heart rate will elevate blood pressure, which keeps blood circulating throughout the body.
Neurogenic Shock vs. Spinal Shock
Neurogenic shock and spinal shock are two separate processes that are often confused for one another because they can both occur after a spinal cord injury.
Unlike neurogenic shock (which occurs at T6 level of injury or higher), spinal shock can occur for injury to any region of the spinal cord.
Spinal shock does not affect the circulatory system the way neurogenic shock does. Neurogenic shock is a disruption of the sympathetic nervous system that affects tone in your blood vessels. Without sympathetic tone, your blood cannot efficiently circulate throughout the body, which results in a slow heart rate and low blood pressure.
In contrast, spinal shock is when the spinal cord experiences inflammation and ischemia (blood blocking). When the spinal cord swells and is unable to receive blood, it cannot get oxygen, which causes it to not function properly.
Spinal shock results in temporary loss of motor, sensory, and reflex functions below the site of injury. Once the inflammation and constriction start to improve, patients will gradually start to recover their sensorimotor functions and reflexes.