Neurogenic Shock

Neurogenic shock is a condition in which you have trouble keeping your heart rate, blood pressure and temperature stable because of damage to your nervous system after a spinal cord injury.

This is a serious condition that can be life-threatening. When nerves can’t tell your blood vessels to tighten, your blood pressure drops. With less pressure, blood flow slows, and your organs don’t get the oxygen and nutrients they need. Damage to your nerves can also slow your heart rate. This makes circulation worse.

Without enough blood flow, your organs may stop working. This could cause them to shut down. Fast care can protect your brain, heart and other organs.

Symptoms of neurogenic shock

Recognizing symptoms quickly is important because this condition can become serious fast. Look out for the following:

• Flushed, warm skin that becomes cold and clammy later
• Lips, nails or gums that look blue, pale or gray (cyanosis)
• Losing some consciousness or not knowing where you are (lethargy)
• Low blood pressure (hypotension)
• Slow heart rate (bradyarrhythmia)

Healthcare providers will make sure you’re safe and stable, especially after a spinal cord injury. Symptoms of the shock phase may last days to weeks. Ongoing symptoms usually come from the original injury.

Neurogenic shock causes

A spinal cord injury is almost always the cause of neurogenic shock. Other causes could include:

• Guillain-Barré syndrome
• Side effects from spinal cord anesthesia
• Toxins that damage your autonomic nervous system
• Transverse myelitis
• Brain injury

Complications of neurogenic shock

Some of the complications can become serious and, in certain cases, even life-threatening if not treated quickly. That’s why close monitoring and timely medical care are so important after a spinal cord injury. Complications may include:

• Low blood pressure (hypotension): After a spinal cord injury, your blood pressure may stay too low for a long time.
• Autonomic dysreflexia: This is a strong and sudden rise in blood pressure.
• Blood clots (deep vein thrombosis): You’re more likely to develop clots in the deep veins of your legs, especially after age 65, if you have limited movement or if your leg muscles are weak.
• Electrolyte changes: Problems with blood pressure and body fluids can sometimes lead to low potassium levels (hypokalemia).
• Bowel problems (paralytic ileus): Your intestines may temporarily stop moving food, which may cause bloating, nausea or discomfort.

How doctors diagnose neurogenic shock

A healthcare provider will diagnose neurogenic shock with a physical exam and some tests.

Your provider will examine your body for signs of injury and damage. If you can, tell your provider what happened right before you noticed shock symptoms.

What tests diagnose neurogenic shock?

Your provider will need some tests, including:

• Blood tests
• CT scan
• Electrocardiogram (EKG)
• MRI
• X-ray

These will show where you have spinal cord damage (and if you have other injuries).

How is neurogenic shock treated?

The main goals of treatment are to restore your normal blood flow and heart rate. You may need:

• A neck brace: This will keep your spine stable.
• Fluids: Your provider will give you an IV infusion through one of your veins to raise your blood pressure.
• Blood pressure medications: Drugs like phenylephrine, epinephrine and norepinephrine increase blood pressure and can also speed up your heart.
• Heart rate medications: Drugs like theophylline, aminophylline and isoproterenol help bring your heart rate back to normal.
• Symptom management: Atropine or glycopyrrolate can help with flushing or feeling too warm.
• Treatments for other injuries: If trauma caused the shock (like from a fall or car crash), you may also need surgery or other care.

When should I see my healthcare provider?

Your healthcare provider will tell you how often you’ll need follow-up appointments after you start treatment. You might need more tests to make sure your heart rate and blood pressure stay at safe levels.

Tell your provider if you feel any new or changing symptoms, especially if your heart’s beating slower or faster than normal.

When should I go to the emergency room?

Call 911 (or your local emergency services number) if you think you have neurogenic shock.

After calling for help, you should lie on your back and prop your legs above the level of your heart. This can help increase your blood pressure while you wait for help to arrive.

What can I expect if I have neurogenic shock?

Neurogenic shock can be a dangerous, sometimes fatal condition. Recovery can take time, especially if you had a spinal cord injury. What you can expect depends on a few factors, like:

• What caused the shock and its severity
• How quickly you’re able to get treatment
• Whether you had other injuries
• Your age
• Your overall health

A spinal cord injury can bring changes to how your body works. And you may need support as you adjust. Your care team might recommend physical therapy or occupational therapy while you recover.

Your provider will help you set realistic goals and expectations based on your unique circumstances.

While your body is physically recovering, this condition and its cause may also affect your emotional health. Ask your provider about support groups or rehabilitation programs that offer counseling, peer mentoring and caregiver education. Talking with a mental health professional can also help you process feelings of depression, anxiety or other challenges. Many people find strength and comfort in connecting with others who understand what they’re going through.

How does neurogenic shock compare to other types of shock?

There are different types of shock that can happen after trauma or injury. Each one targets your body in a different way:

• Neurogenic shock: This usually happens after a spinal cord injury. It affects circulation, causing low blood pressure and a slow heart rate.
• Hypovolemic shock: This happens when you lose too much blood or fluid. It causes low blood pressure and a fast heart rate.
• Spinal shock: This happens right after a spinal cord injury. Spinal shock causes temporary loss of reflexes, movement and muscle tone below the injury.