Which mechanism of spinal cord injury occurs when the head turns beyond the normal range?

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.

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:

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).

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:

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.

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.

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.

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.

Last reviewed by a Cleveland Clinic medical professional on 11/30/2021.

References

• MedlinePlus. Shock. (https://medlineplus.gov/ency/article/000039.htm) Accessed 11/30/2021.
• Merck Manual Consumer Version. Shock. (https://www.merckmanuals.com/home/heart-and-blood-vessel-disorders/low-blood-pressure-and-shock/shock#v718790) Accessed 11/30/2021.
• Sagar D, Cho JJ. StatPearls. Neurogenic Shock. (https://www.ncbi.nlm.nih.gov/books/NBK459361/) StatPearls Publishing; 2021 Jan. Accessed 11/30/2021.
• World Health Organization. Spinal Cord Injury. (https://www.who.int/news-room/fact-sheets/detail/spinal-cord-injury) Accessed 11/30/2021.

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If you or a loved one has recently suffered a spinal cord injury (SCI), you may be hearing a lot of unfamiliar terms from doctors. One medical term that many people only hear about after suffering an SCI is "spinal shock." What shock in this context? More importantly, how can this medical condition be treated?

What Is Spinal Shock/Spinal Shock Syndrome?

Spinal shock is characterized by the temporary reduction or loss of reflexes following a spinal cord injury. The spinal cord, which is comprised of bundles of delicate nerves encased within a protective column of vertebrae, serves as the communication superhighway for your brain to transmit signals to the rest of your body.

When the spinal cord is injured, there may be a permanent or temporary loss of activity and sensation below the level of the injury. In general, the more severe the injury, the worse the autonomic dysfunction will be. However, spinal shock alone cannot be used to determine your medical prognosis or assess the severity of a spinal cord injury.

Spinal shock syndrome is really a combination of various reflex and neurological concerns, including hyporeflexia (the condition of sub-standard or absent reflexes) and autonomic dysfunction. Autonomic dysfunction refers to problems with the autonomic nervous system which controls the ‘automatic’ things your body does such as maintaining your blood pressure and heart rate.

Spinal shock is closely related to another form of shock called neurogenic shock. Both conditions have similar causes, but have different effects. As noted in a ScienceDirect topic page, “Neurogenic shock describes the hemodynamic changes resulting from a sudden loss of autonomic tone due to spinal cord injury. Spinal shock, on the other hand, refers to a loss of all sensation below the level of injury and is not circulatory in nature.”

Spinal Shock Anatomy and Pathophysiology

Understanding the pathophysiology – defined by Merriam-Webster as “the functional changes that accompany a particular syndrome or disease” – in spinal shock cases can be aided by understanding the anatomy of the spinal cord.

The spinal cord and its nerve bundles can be broken down into four major sections:

• The Cervical Spinal Cord. This is the uppermost section of the spinal cord where the brain connects to the rest of the nervous system. This part of the spinal cord is contained in the cervical vertebrae (labeled C1-C7, with an extra section of cord labeled C8 located between the C7 vertebra and the T1 vertebra).
• The Thoracic Spinal Cord. This section of the spinal cord is located in the upper back and is contained within the thoracic vertebrae (Labeled T1-T12).
• The Lumbar Spinal Cord. The section of the spinal cord contained in the lower back. The lumbar spinal vertebrae (labeled L1-L5) actually contain the end of the spinal cord proper.
• The Sacral Spine. While the spinal cord ends in the lumbar spine, there are spinal nerve bundles located in the sacral spine – which is the lower, triangle-shaped bone structure at the base of the spine consisting of five vertebrae – several of which are fused together.

Damage to different levels of the spinal cord will have different effects. Generally speaking, the higher up on the spinal cord an injury (i.e., the closer to the brain it is), the worse the effects will be.

What Happens after a Spinal Shock?

After a spinal shock, the spinal cord enters either hyporeflexia – a significant reduction in reflexes – or areflexia – the temporary loss of reflexes. Because reflexes help to prevent harm, their temporary loss can be dangerous. More importantly, since most SCI survivors are hospitalized in a safe environment following their injuries, the loss of reflexes signals serious spinal functioning issues.

In the hours immediately following a spinal shock, SCI survivors might not even realize that they are in spinal shock. Other, more urgent injuries are typically a higher priority.

Stages/Phases of Spinal Shock

According to research by Dr. Dittuno of Thomas Jefferson University, there are four stages to spinal shock. Early stages often begin with patients experiencing an “anaesthetized feeling” of the body below the injury, however this can be tricky to determine as only a day following injury, the extent of injury is still being assessed – and the application of actual anesthesia during treatment immediately after an injury can further confuse the early stages of spinal shock.

1. One to two days following the injury: Nerve cells become less responsive to sensory input, resulting in full or partial loss of spinal cord reflexes. This is known as hyporeflexia.
2. One to three days following injury: Initial return of some reflexes. Polysynaptic reflexes — those that require a signal to travel from a sensory neuron to a motor neuron — tend to return first. The delayed plantar reflex, a variation of the normal plantar reflex common among SCI survivors, typically returns first. Next is the bulbocavernosus reflex, which causes the anal sphincter to tighten in response to squeezing the clitoris or head of the penis. Many doctors test for the bulbocavernosus reflex to assess spinal cord injuries.
3. One to four weeks following the injury: Hyperreflexia, a pattern of unusually strong reflexes, occurs. This is the result of new nerve synapse growth, and is normally temporary.
4. One to twelve months following the injury: Hyperreflexia continues, and spasticity may develop. This process is due to changes in the neuronal cell bodies, and takes much longer than the other stages.

So, how can you tell whether you have spinal shock? Spinal shock is characterized by a variety of symptoms and everyone experiences their SCI differently. This fact makes it difficult for doctors to differentiate spinal shock symptoms from those that result directly from the spinal cord injury itself.

Symptoms of Spinal Shock

Below is a list of some symptoms that may accompany the different stages of spinal shock. Of course, it can be challenging for doctors to determine whether or not they are looking to treat spinal shock or if they’re looking at issues created directly from the spinal cord injury. Spinal shock is characterized by:

• Altered body temperature
• Skin color and moisture changes (such as dry and pale skin)
• Abnormal perspiration function (decreased or increased sweating, flushing)
• Increased blood pressure and slowed heart rate
• Irregularities in the musculoskeletal system
• Altered sensory response
• Unusual urinary bladder and GI tract functions (overflow and incontinence)
• Irregular vasomotor response
• Depressed genital reflexes

All patients of spinal cord injury, and spinal shock, will experience it differently. Although there are general symptoms (such as those listed above), you cannot predict the kind of reaction an individual’s body will take following a spinal cord injury.

In the first few days following an SCI, doctors will be keeping a close eye on the patient so they can evaluate if any symptoms are demonstrative of spinal shock or are due to the injury itself. Spinal shock death is rare, and most deaths among spinal shock patients is caused by the original injury rather than the condition.

What Causes Spinal Shock?

Just as your body goes into a state of shock after a life-threatening injury, your spinal cord goes into a state of shock after an injury. Almost all people with spinal cord injuries experience some degree of spinal shock, but the severity tends to be greater when the spinal cord is severed, or when it is extremely swollen.

Differential Diagnoses of Spinal Shock

A “differential diagnosis” is a list of possible conditions that may be causing the specific symptoms that a person is experiencing. Doctors may provide their patients with a list of differential diagnoses for a condition based on things like:

• Presence or absence of specific symptoms commonly associated with the disease/condition;
• Presence of symptoms not normally associated with the condition;
• Whether there are triggers for any symptoms;
• Medical history (personal and familial) that may make someone susceptible to specific conditions;
• Medications or recreational substances the patient uses frequently; and
• Recent major events (such as accidents, loss of a job, introduction of a new pet, etc.) that can cause injury, stress, or a significant change in environment.

Doctors may try to identify differential diagnoses by performing some tests in controlled conditions. This way, they can verify if there are specific triggers for symptoms that are more in line with a differential diagnosis other than spinal shock.

Some examples of differential diagnoses for spinal shock symptoms include:

• Urinary Tract Infections (UTIs). Changes in bladder or bowel function may be caused by infections of those bodily systems rather than spinal shock from an SCI.
• Melanoma and Skin Infections. Melanoma or some skin infections may cause changes in skin color and skin moisture.
• Malnutrition (Mild to Severe). Improper nutrition can cause a broad range of symptoms, including abnormal muscle function, altered sensory function, and unusual heart rate or blood pressure (among other things).

This is just a small sample of the differential diagnoses that share one or more symptoms with spinal shock—there are many more conditions than could be listed in a short article.

How Do Doctors Separate Spinal Shock from Other Conditions?

In many cases, the identification of spinal shock as a separate condition from other potential diagnoses is based on a close examination of the patient and taking into account when the symptoms appeared—such as them only appearing within a day of the patient being in a major auto accident or suffering a slip and fall incident.

How Long Does Spinal Shock Last?

Spinal shock is a short-lived phenomenon, and can be divided into specific, predictable stages. It can start roughly 30 minutes after an injury, and last six weeks (though spinal shock duration can vary from this in some cases).

While spinal shock is typically characterized by being temporary, it can be permanent in a few cases. This may be why some people think that spinal shock is a permanent loss of some of the spinal cord’s functions rather than a temporary condition (permanent loss is usually caused by an SCI or brain injury).

How Do I Know When Spinal Shock is Over?

It can be difficult for some spinal shock patients to know exactly when their condition is “over” and they can be considered as fully recovered as they can be. In some cases, spinal shock signs and symptoms never fully go away.

Generally speaking, a doctor should be the one to provide the official “all clear” to let a patient know that their condition is over. However, different doctors/physicians may use different criteria to judge that the condition has ended.

According to a study featured on the U.S. National Library of Medicine National Institutes of Health, “Some clinicians interpret spinal shock as ending with the appearance of the bulbocavernosus reflex… Others state that spinal shock ends with the recovery of deep tendon reflexes.”

Spinal Shock Treatment

Spinal shock is to spinal cord injuries as fevers are to infections. Spinal shock is merely a symptom of an underlying problem, not a disease itself. Spinal shock is not typically dangerous, and other symptoms of SCI are far more likely to cause serious, lasting physiological issues. Treatments for spinal cord injury-related spinal shock include:

• Physical and occupational therapies.
• Exercise therapy to strengthen muscles and maintain a healthy body weight.
• Medications such as painkillers, antibiotics, and antidepressants.
• Psychotherapy to aid in coping with and managing the injury.
• Family education to help your loved ones understand your injuries.
• Use of supportive or assistive technologies, such as a wheelchair or an artificial respirator.
• Support groups to help you meet and learn from others’ experiences that can serve as a resource.

All patients of spinal cord injury, and spinal shock, will experience it differently. Although there are general symptoms (such as those listed previously), you cannot predict the kind of reaction an individual’s body will take following a spinal cord injury.

Consequently, treatment for spinal shock tends to focus on treating the spinal cord injury as a whole. In the immediate aftermath of a spinal cord injury, treatment may include:

• Surgery to remove bone fragments or items lodged in the spinal cord.
• Spinal fusion surgery.
• Various brain and spinal cord imaging tests, as well as functional tests such as assessments of reflexes, cognition, and motor skills.
• Antibiotics to treat or prevent infections.
• Assisted respiration.
• Planning for release to a rehabilitation facility.
• Mental health counseling.

Spinal cord injuries vary greatly from person to person, and can change in response to physical therapy. Moreover, it’s difficult to predict the prognosis until swelling diminishes. Thus the early days of treatment center around stabilization, future planning, and adjustment to the shock of a SCI.

Spinal Shock Complications

The complications of spinal shock can be similar to SCI complications since SCIs are a common cause of spinal shock – spinal shock itself is listed as a complication of SCI. Some complications that can arise from spinal shock include:

• Loss of muscle control and inability to balance because of the loss of sensation below the injury site;
• Hyperreflexia as synapse growth ensues;
• Spasticity (again because of synapse growth or abnormalities in connections of the nervous system to affected muscle groups);
• Depression caused by various neurological and environmental factors; and
• Urinary tract infections from irregularities in bowel and bladder function.

Prognosis of Spinal Shock

Spinal shock tends to follow predictable patterns — though no specific treatment is deemed necessary above others. The presence of spinal shock, however, suggests a serious spinal cord injury. Yet, it should be noted that the severity of the spinal shock is not a good gauge for either the severity or the prognosis of the spinal cord injury.

Spinal cord injuries tend to change over time. The more severely compressed the spinal cord is, the less likely full recovery will be. If the spinal cord is severed, full recovery is extremely unlikely. The location of the injury is also a good indicator of prognosis. The lower the injury is, the less severe the mobility and other impairments will be.

Neurogenic Shock: A Related Condition

In people who suffer spinal cord injuries above their thoracic nerves (specifically above the T6 nerve), neurogenic shock can occur. Neurogenic shock can also be caused by disruptions in the autonomic system. Because the autonomic nervous system regulates automatic functions such as heart rate, low blood pressure and slowed heart rate can occur.

Left untreated, neurogenic shock can cause organ failure, proving fatal. A variety of drugs, including vasopressin and dopamine, may reduce the effects of neurogenic shock. Assistive respiration devices, heart monitoring, and other tools may also be necessary until neurogenic shock is well-controlled.

Spinal shock and neurogenic shock often co-occur. While spinal shock resolves on its own, neurogenic shock is a medical emergency.

Living with a spinal cord injury is something that you don’t have to do alone. There are hundreds of thousands of people in the U.S. living with spinal cord injuries. We have an online community of SCI injury survivors and family members you can connect with to discuss your injuries, share experiences, and share helpful coping tips or information.