Neurogenic shock is a condition when blood cannot flow normally to body tissues due to damage to the nervous system. If left untreated, neurogenic shock can be fatal. Therefore, early identification and prompt treatment are needed.
Neurogenic shock, also known as vasogenic shock, usually occurs as a result of spinal cord injury. The injury causes impaired sympathetic function of the nervous system, which is the function that regulates heart rate, blood pressure, and breathing.
If the sympathetic nervous system cannot function properly, blood pressure in the body can drop drastically suddenly (shock) so that blood circulation throughout the body becomes not optimal. As a result, damage occurs in various body tissues.
Causes of Neurogenic Shock
Neurogenic shock occurs due to damage to the nervous system that causes disturbances in sympathetic function. The sympathetic nervous system functions to strengthen the heartbeat, increase blood pressure and flow, and widen the respiratory tract.
When the sympathetic nervous system is not functioning, the blood vessels are dilated so that they are unable to encourage blood flow throughout the body. This causes a decrease in blood pressure, which is followed by a decrease in blood flow to cells, tissues, and organs.
Nervous system damage is generally caused by injury or trauma to the spinal cord. Trauma can result from gunshot wounds, traffic accidents, or sports injuries.
Spinal cord injuries that cause neurogenic shock can be divided into two types, namely:
- Primary spinal cord injury, which is damage to the nervous system that occurs shortly after the injury
- Secondary spinal cord injury, which is damage to the nervous system that occurs hours or days after the injury
In addition to spinal cord injury, several other conditions or diseases that can also cause neurogenic shock are:
- Use of drugs that affect sympathetic nerve function
- Lack of oxygen to the brain, for example due to a stroke
- Subarachnoid hemorrhage
- Meningitis (inflammation of the lining of the brain)
Although very rare, neurogenic shock can also result from seizures in epilepsy, Guillain-Barre Syndrome, and brain hernias. Some procedures close to the spine, such as surgery or administration of anesthesia, can also cause neurogenic shock.
Symptoms of Neurogenic Shock
Neurogenic shock is an emergency situation characterized by a simultaneous decrease in vital signs, namely:
- Decreased blood pressure (systolic pressure <100 mmHg)
- Decreased heart rate (pulse <60 beats per minute)
- Decrease in body temperature (temperature <36.5°C)
These signs are usually followed by the following symptoms:
- Dizzy
- Nauseous
- Throw up
- blank view
- Faint
- Excessive sweating
- Nervous
- pale skin
In more severe conditions, sufferers may also experience other symptoms, such as:
- Hard to breathe
- Chest pain
- Weakness
- Blue lips and fingers (cyanosis)
- The pulse is hard to feel
- Shivering
When to go to the doctor
Seek immediate medical attention if you experience the symptoms of neurogenic shock as mentioned above, for example if you have a spinal injury accompanied by nausea or dizziness, and chest pain.
It's important to remember, don't wait for symptoms to get worse. Neurogenic shock is a dangerous condition and can be fatal, so treatment as early as possible is necessary.
Neurogenic Shock Diagnosis
Neurogenic shock is an emergency condition that must be treated immediately to avoid fatal consequences. Diagnosis is made quickly by asking for a history of events before the shock occurred and performing a quick vital sign examination. After that, emergency treatment will be carried out until the patient's condition is stable.
After the patient's condition has stabilized, the doctor will perform additional investigations to determine the cause of neurogenic shock, such as:
- CT scan, to see the condition of the spine and detect bleeding or other damage
- MRI, to see the condition of the spinal cord or brain to see any abnormalities
Neurogenic Shock Treatment
Neurogenic shock must be treated immediately to avoid permanent organ damage. Emergency treatment aims to stabilize the patient's vital signs, such as blood pressure, heart rate and respiration, and avoid further injury or damage.
In neurogenic shock caused by spinal cord injury, treatment begins by minimizing changes in the patient's body position or by immobilizing the patient at all. This aims to prevent further damage to the nervous system.
If needed, the doctor will perform the following actions:
- Attach a support to the patient's airway and provide oxygen support
- Increase blood pressure by giving intravenous fluids and blood vessel narrowing drugs, such as dopamine, norepinephrine, epinephrine, and vasopressin
- Increase heart rate by giving the drug atropine.
Further treatment will be carried out after the cause of neurogenic shock has been identified. In neurogenic shock caused by spinal trauma, spinal surgery will be performed to repair the damage to the injured spinal cord.
Complications of Neurogenic Shock
Neurogenic shock can cause permanent damage to organs or tissues of the body that do not receive an adequate blood supply. This can occur simultaneously in all organs so that it can cause death.
Neurogenic Shock Prevention
The best way to prevent neurogenic shock is to avoid the underlying cause. One way that can be done is to prevent injury to the spinal cord, for example:
- Drive carefully, such as always wearing a seat belt and not driving when drunk or sleepy
- Always check the water depth before jumping into the water
- Avoid the risk of falling
- Take care when exercising, for example by wearing proper protection