Neurogenic Shock

What is 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. Like other types of shock, this is a serious condition that can be fatal because your blood flow is too low. Without normal blood flow, your cells can’t get the oxygen and nutrients they need to do their jobs.

You should get treatment for shock right away.

Neurogenic shock vs. spinal shock
With spinal shock, your muscles are limp and you don’t have your reflexes after a spinal cord injury.

Neurogenic shock vs. hypovolemic shock
If you have neurogenic shock, you have a slow heart rhythm. If you have hypovolemic shock, you have a fast heart rhythm.

Who does neurogenic shock affect?

People whose nervous system is hurt after a spinal cord injury can get neurogenic shock.

How common is neurogenic shock?

Studies estimate that 19% to 31% of people with a spinal cord injury get neurogenic shock. Each year, about 8,000 to 10,000 people in America injure their spinal cord — mostly through car crashes and falls.

How does neurogenic shock affect my body?

When you have a spinal cord injury, it can prevent your nerves from telling your blood vessels to constrict. Without getting this command, your blood vessels can open up too much (vasodilation). This lowers your blood pressure and your blood flow, which means your organs can’t get enough oxygen.

What are the symptoms?

Symptoms of neurogenic shock include:

• Low blood pressure (hypotension).
• Slow heart rhythm (bradyarrhythmia).
• Flushed, warm skin that gets cold and clammy later.
• Lips and fingernails that look blue.
• Lack of full consciousness.

What causes neurogenic shock?

Causes of neurogenic shock include:

• Spinal cord injury (the most common cause).
• Autonomic nervous system toxins.
• Guillain-Barré syndrome.
• Spinal anesthesia.
• Transverse myelitis.

How is neurogenic shock diagnosed?

To diagnose neurogenic shock, your healthcare provider will:

• Give you a physical exam.
• Check your vital signs.
• Do blood tests.
• Order scans.

What tests will be done to diagnose neurogenic shock?

Your provider may order these scans:

• Computed tomography (CT).
• Magnetic resonance imaging (MRI).

How is neurogenic shock treated?

Your provider will put a collar or neck brace on your neck to keep your injury from getting worse.

First, your provider will treat your low blood pressure with fluids you receive through an IV. Next, your provider will treat your slow heart rhythm. In addition to neurogenic shock treatment, providers will also give you treatment for injuries from your accident.

What medications/treatments are used?

For neurogenic shock management, your provider may order several different medicines, including:

• Phenylephrine (Suphedrin PE®).
• Norepinephrine.
• Epinephrine (EpiPen®).
• Atropine (Atropisol®).
• Glycopyrrolate.
• Isoproterenol.
• Theophylline (Uniphyl®).
• Aminophylline.

Complications/side effects of the treatment

Any medications can have side effects, but your provider chooses medicines with benefits that outweigh the risks. Also, there is a chance that the IV fluids you get can lead to swelling.

How can I reduce my risk?

Preventing a spinal cord injury greatly reduces your risk of neurogenic shock. To do this, you can try to avoid accidents that can cause a spinal cord injury in these ways:

• Make sure you’re sober when driving.
• Put on your seat belt in the car.
• Avoid diving into water.

What can I expect if I have neurogenic shock?

It’s possible to have hypotension (low blood pressure) for five weeks after your injury. You may also get a deep vein thrombosis (DVT), stress ulcer or aspiration pneumonia (from inhaling something other than air).

How long neurogenic shock lasts

Neurogenic shock symptoms can last four to five weeks.

When can I go back to work/school?

Returning to work or school will depend on the extent of your spinal cord injury and other injuries from your accident. You may need to make major changes in your life to accommodate your limited mobility.

Outlook for neurogenic shock

Without treatment, shock is most often fatal. With treatment, your outlook depends on:

• Your age.
• The severity of your injury.
• Injuries to your organs.
• Your other medical problems.
• How long you have to wait for treatment.
• Other problems like being unable to speak or balance.
• How well your body responds to treatment.

Having a spinal cord injury makes you two to five times as likely to die early compared to those who don’t have that injury. The risk of death is highest in the first year after a spinal cord injury.

How do I take care of myself?

Because of your spinal cord injury, you’ll be more likely to have other problems like deep vein thrombosis. Also, one or more of your organs may be damaged because of the lack of blood flow during neurogenic shock. Every case is different, but anyone who’s had neurogenic shock should keep up with physical therapy and provider appointments to prevent future problems.

When should I see my healthcare provider?

You should contact your provider if anything changes with your condition: vital signs, your pain level, etc.

When should I go to the ER?

You should get immediate help if you have:

• Chest pain.
• Dizziness.
• Nausea.

What questions should I ask my doctor?

• What is the outlook for my specific situation?
• Do I have organ damage from neurogenic shock?
• What are the most important things for me to do in my situation?

A note from Cleveland Clinic
Neurogenic shock is a medical emergency that needs to be treated as soon as possible. Once you’re out of immediate danger, you can focus on the longer-term impact of your spinal cord injury. Your healthcare team can help you make a plan for how to manage your medical and mobility issues.