Neurogenic Shock

Neurogenic Shock






Neurogenic shock occurs after serious injury to the nervous system and/or spinal cord. This is a potential complication and can cause organ dysfunction or even death. Often neurogenic shock occurs after acute spinal cord injury in 80-90% of cases. Cervix is the worst affected area because of this shock and sometimes the thoracic and lumbar region are also affected. Unlike spinal shock which occurs due to temporary spinal reflex action this shock is permanent. The major consequences of this shock are hypotension and bradycardia. It causes loss of autonomic tone and any disruption of sympathetic path would result in vagal tone leading to vasodilation.

A person having neurogenic shock is at increased risk of spinal cord ischemia. Many hemodynamic changes take place within the system due to shock leading to reversible reduction of sensory and motor functions of spinal cord.

Types of Shock :

Any type of shock can damage multiple organs of your body. Shock occurs when the body lacks enough blood flow. Cardiogenic shock occurs due to heart problems, anaphylactic shock occurs due to allergic reaction and hypovolemic shock happens due to black of blood quantity and Septic Shock occurs due to infections and neurogenic shock occurs due to nervous system damage or spinal cord injury.

Causes :

Neurogenic shock occurs when there is severe injury to the spinal cord or central nervous system. The trauma or injury results in loss of sympathetic nerve stimulation of blood vessels which would return back to relaxed position (vasodilation) causing sudden decrease in Blood Pressure. This sudden low blood pressure leads to neurogenic shock causing risk to brain and spinal cord. This type of shock needs prompt medical treatment failing which the consequences can be fatal.

The person affected with neurogenic shock cannot have normal functions of dilation and contraction of blood vessels. It would impair the normal blood circulation causing hypothermia due to poor circulation of blood. Some people develop bradycardia which is reduction of heartbeat rate.

Symptoms :

Some of the signs of neurogenic shock are sudden low blood pressure, lack of oxygen to the tissues, cardiac arrest (for some people), increased heartbeat, dull eyes, shallow breathing, weakness, feeling unconscious, anxiety, restlessness, hypothermia, dryness in the mouth and confusion.

Diagnoses :

The doctor will look for vital signs of the patient by measuring his blood pressure and monitoring his heartbeat. Special catheters would be inserted into the veins of neck and chest for measuring the right pressure in the heart. Tubes are inserted in the bladder for measuring urine output. Blood test and radiologic tests are administered after giving the patient first-aid.

Treatment :

After examining the patient with neurogenic shock the doctor will put him on intravenous fluids. Hypotension caused cannot be due to neurogenic shock only since it can be due to hemorrhage (loss of blood). Patients who have met with accidents will be on heavy blood loss leading to hemorrhagic shock. Such patients will be treated with crystalloid or colloid fluids to prevent continuous blood loss. Then he should be resuscitated followed by spinal cord decompression.

The fluid level should be regularized first by utilizing pressor agents. Dopamine is injected along with inotropoic agents. For major trauma certain types of vasopressors are given in the form of first line treatment. Hypotension should be treated promptly to avoid ischemic arrest. Next he will be given supplementary oxygen depending on his health condition and examining his vital signs. In the emergency unit, diagnoses and treatment will be done simultaneously.

For severe blood loss, blood transfusion is done. If bleeding is not the cause for shock, IV fluids are started to normalize the volume of fluids in the blood vessels. Careful examination and evaluation of the brain and vertebral column is necessary for locating the injury of spine.

Neurogenic Shock – Symptoms, Causes, Treatment

Neurogenic Shock – Symptoms, Causes, Treatment

What is a Neurogenic Shock?

A shock is considered to be a life-threatening condition wherein there is insufficient supply of blood flow to the body. There are five common types of shock and one of the most striking in the neurogenic shock. Neurogenic type of shock occurs when there is an injury to the central nervous system e.g., the brain and the spinal cord, disrupting in the function of the nervous system, affecting the blood distribution throughout the body.

The other types of shock are cardiogenic (heart problems), hypovolemic (inadequate blood volume), anaphylactic (allergic reaction), and septic (infections).

Although these types of shock may have different and specific causes, but most of them show the same manifestations.

Neurogenic Shock Symptoms

• Low Blood Pressure – it usually reaches up to 60 mmHg


• Increased heart rate – it reaches more than 120 beats per minute.


• Difficulty breathing – the acts of breathing needs more effort than the usual and normal breathing pattern.


• Pale skin – this happens because there is already a reduced number of red blood cells in the circulation.


• Hyperhidrosis – Normal sweating happens all the time most especially in warm environment. However, hyperhidrosis is an abnormal and Excessive Sweating even when the body is not exposed to warm temperature.


• Lethargy – this is a manifestation of an impaired mental capacity. Most of those that are lethargic cannot think clearly so they have impaired judgment and associated symptoms which are the following:
  
  
  
  • Confusion
  
  
  • Anxiety
  
  
  • Difficulty speaking and walking
  
  
  • Hallucinations
  
  
  • Depression
  
  
  • Memory loss
  
  
  
  


• Fainting – this happens when there is a short moment of unconsciousness followed by recovery. The following symptoms of fainting:
  
  
  
  • Dizziness
  
  
  • Lightheadedness
  
  
  • Flushing
  
  
  • Nausea
  
  
  • Excessive sweating
  
  
  • Palpitations
  
  
  • Rapid pulse
  
  
  • Weakness or fatigue
  
  
  
  


• Cool limbs and warm skin


• Confusion – Since the patient has impaired mental capacity, he would be unable to speak


• Coma – the individual would be unconscious and does not react to stimulation

Neurogenic Shock Causes

Neurogenic shock can be due to a severe damage to the central nervous system such as the brain and the higher levels of the spinal cord especially the cervical and thoracic regions. The mechanism is that once the there is trauma, the sympathetic functions of the body will be disrupted which might lead to the relaxation of the blood vessels, thereby decreasing the blood flow to the entire system. If not promptly managed, neurogenic shock can be life-threatening as continuous insufficiency in blood supply will cause cell death and organ failure.

• Heart problems – this can be associated with Heart Attack or heart failure. Cases like this would obviously affect the return of deoxygenated blood from the system to the heart and the distribution of oxygenated blood back to the system will also be diminished thus leading to cell death and organ failure.


• Decreased blood volume secondary to bleeding or dehydration


• Severe allergic reactions


• Medications that can alter the normal flow of the blood throughout the body

Neurogenic Shock Treatment

• Fluid replenishment is the best initial treatment of shock. Some institutions would utilize the use of pressor agents to maintain hemodynamic stability of the body.


• The use of dopamine (Intropin)


• Use of the antidiuretic hormone, vasopressin


• Atropine – this will speeds up heart rate and increases cardiac output

Furthermore, here are the First Aid tips in managing shock:

You're reading Neurogenic Shock – Symptoms, Causes, Treatment posted by minhhai2d, the information is for reference only.

• Immediately call 911 for help.


• Check for ABC (airway, breathing, and circulation). Begin CPR if necessary.


• Even the person is breathing independently, always check the patient every 5 minutes until help arrives.


• If there’s no identified injury and the patient is conscious, position him in shock position. Lay the patient I supine (on the back) and elevate the legs about 12 inches high. Make sure to not elevate the head. However, if raising the leg causes discomfort, position the patient in supine or flat lying.


• Always provide appropriate first aid for wounds or injuries.


• Always keep the patient comfortable by loosening tight clothing.

What happens if the person is vomiting?

• To prevent the patient from choking, turn the head toward the side.


• If spinal cord injury is probable, keep the person’s head, neck, and back in the same level. Log roll the person if possible.

The following are things to avoid:

• Do not give anything by mouth whether liquid or solid to prevent choking.


• Do not to move the person if spinal cord injury is probable.


• Do not wait for mild symptoms to get worse before calling for help by emergency medical service.

It is always necessary to know ways on how to prevent cases such as heart disease, dehydration, and other scenarios that may lead to shock. If someone is showing symptoms of shock, it is always necessary to attend to the person immediately to prevent life-threatening results.