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Neurogenic shock

Neurogenic shock is a condition which occurs due to a disruption of blood circulation as a consequence of damage to the brain and spinal cord. It can lead to a lack of muscle tone and if left untreated, neurogenic shock can result in an irreversible damage to the body tissues and is life-threatening. Therefore, immediate medical attention is required to treat the condition.

Symptoms

The primary symptom of neurogenic shock is a very low blood pressure (severe hypotension) which may be manifested in the form of the following symptoms:

  • Pale skin
  • Dizziness
  • Fainting
  • Profuse sweating
  • Blank stares
  • Anxiety
  • Nausea
  • Vomiting

In case of severe neurogenic shock the symptoms may include:

  • Chest pain
  • Breathing difficulty
  • Faint pulse
  • Weakness
  • Decrease in body temperature (hypothermia)
  • Slow heart rhythm (bradycardia)
  • Bluish discoloration of lips and fingers (cyanosis)

Call for immediate medical help if any of the above symptoms are experienced.

Causes

Neurogenic shock occurs due to damage to the brain and spinal cord leading to a loss of stimulatory output from the brain. This results in three different changes in the hemodynamic including hypotension, dilation of blood vessels in the periphery and a decrease in heart rate. Brain and spinal cord injury might happen due to any of the following causes:

  • Head injury or trauma from motor-vehicle accidents
  • Sports injuries of the spine
  • Use of medications which affect the breathing and certain involuntary functions
  • Inappropriate administration of anesthesia to the spinal cord during surgeries
  • Gunshot wounds on the spine

Diagnosis

Usually diagnosis and treatment are performed simultaneously considering neurogenic shock as an emergency condition. The doctor may perform a physical examination of the patient and also checks the blood pressure. Additionally, the following tests may be ordered to understand the severity of the injury:

  • CT scan is performed to check for internal bleeding or any other damage to the brain and spinal cord by looking at the images generated using x-rays.
  • MRI scan is another type of imaging test which may be ordered to detect any irregularities in the spinal column.
  • Urine tests may be ordered to check for the signs of infection.

A urinary catheter may be placed to measure the volume of urine eliminated during a specific period. Certain injuries of the spinal cord can lead to a urinary incontinence or difficulty with urination.

Sometimes a differential diagnosis may be performed to rule out other types of shock such as septic shock, hypovolemic shock, cardiogenic shock and spinal shock.

Treatment

Neurogenic shock is a medical emergency which needs a prompt treatment. Any delay in the treatment can cause an irreversible damage to the different tissues of the body. The main aim of the treatment is to stabilize the patient and prevent any further tissue damage. Neurogenic shock is a dangerous condition which is difficult to manage.

The first measure taken by the doctor is to immobilize the patient to prevent further damage.

The doctor then examines the condition of the patient while giving special attention to circulation, airways and breathing pattern.

Medicines to treat neurogenic shock may include:

  • Intravenous fluids may be administered to stabilize the blood pressure. Additionally, vasopressor agents may be given to treat severe hypotension by constricting the blood vessels.
  • Intravenous (IV) atropine may be given to improve the heart rate.
  • IV steroids may be administered within 8 hours of occurrence of neurogenic shock to prevent permanent paralysis.
  • Ionotropic agents such as dopamine may be given in the form of an infusion to replenish the bodily fluids.

In case of bleeding associated with a trauma or accident, crystalloid or colloid fluids may be given to reduce further bleeding or in severe cases of bleeding, a blood transfusion may be necessary. If the condition is severe a surgery may be necessary.

 

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