We've all heard the word "shock," right? Sometimes we think of it as something else when we suddenly get scared or upset. But in medicine, "shock" refers to a much more serious condition. Today we're going to talk about a similar, but slightly different type of "shock." This is called 'neurogenic shock.' Simply put, it occurs when there is a severe injury to our nervous system, especially the spinal cord .
What exactly is 'Neurogenic Shock'?
Think of your nervous system as a telephone system in a country. These nerves carry messages from the brain to every part of the body. Now, when there is an injury to this nervous system, especially to the spinal cord, such as a spinal fracture or a contusion, the system that carries these messages becomes disrupted.
Neurogenic shock is a condition in which your heart rate, blood pressure, and body temperature become uncontrollable after an accident. Like other types of shock, this is a very serious condition, and can sometimes be fatal. The reason for this is that blood flow throughout the body is disrupted. When blood does not flow properly, our cells do not get the oxygen and nutrients they need. Then the cells cannot do their jobs.
Therefore, it is essential to seek treatment for shock as soon as possible.
What is the difference between 'Neurogenic Shock' and 'Spinal Shock'?
Although both are related to spinal cord injuries, there is a slight difference. In spinal shock, your muscles become paralyzed and your reflexes are lost after an injury to your spinal cord. In neurogenic shock, the main effects are on your heart rate and blood pressure.
What is the difference between 'Neurogenic Shock' and 'Hypovolemic Shock'?
Hypovolemic shock is a condition caused by the loss of too much fluid, especially blood, from the body. The main difference between the two is the heart rate.
- A person with neurogenic shock has a slow heart rate (bradyarrhythmia).
- A person with hypovolemic shock has an increased heart rate (tachycardia).
Who is most affected by this condition? How common is it?
Neurogenic shock occurs in people who have suffered an injury to the spinal cord and have damaged the nervous system.
Research suggests that between 19% and 31% of people who have suffered a spinal cord injury may develop this condition, known as 'Neurogenic Shock'. Even in a country like America, between 8,000 and 10,000 people suffer from spinal cord injuries every year. The main causes of this are car accidents and falls from heights. Such accidents are common in our country too, aren't they?
How does 'Neurogenic Shock' affect my body?
Simply put, when there is an injury to the spinal cord, our nerves are unable to send signals to the blood vessels, saying, "Okay, now constrict a little." When this message is not received properly, the blood vessels become too large, which is called `vasodilation` . It's like a water pipe suddenly becoming larger. What happens is that blood pressure suddenly drops `hypotension` . When blood pressure drops, blood flow throughout the body also decreases. This means that our vital organs don't get the oxygen they need.
What are the symptoms of this?
Symptoms of neurogenic shock include:
- Low blood pressure (Hypotension): This is the main symptom.
- Slow heart rate (Bradyarrhythmia): The number of beats per minute is usually reduced.
- The skin becomes red and hot, then cold, sweaty, and clammy.
- Lips and fingernails turn blue: This is due to a lack of oxygen in the blood.
- Complete loss of consciousness or reduced consciousness: This can occur due to reduced blood flow to the brain.
If someone has one or more of these symptoms, especially if they have suffered a spinal cord injury, they should be given immediate attention.
What are the causes of 'Neurogenic Shock'?
There are several main reasons for this situation:
- Spinal cord injury: This is the most common cause. It can be caused by things like a car accident, a fall from a height, or a sports accident.
- Toxins that affect the autonomic nervous system.
- Guillain-Barré syndrome: This is a rare condition that affects the nervous system.
- Spinal anesthesia: This anesthesia is given for some surgeries. It can occur very rarely as a complication.
- Transverse myelitis: This is also an infection of the nerves in the spinal cord.
How do doctors diagnose this?
To diagnose whether you have neurogenic shock, the doctor will do the following:
1. A physical exam is performed: Your condition and the nature of the injury are examined.
2. Vital signs are checked: blood pressure, heart rate, respiratory rate, and temperature are measured.
3. Blood tests: Learn about the internal state of the body and the functioning of organs.
4. Scans are ordered: To accurately assess the damage to the spine.
What kind of scans are done?
These are the two main types of scans:
- CT Scan (Computed Tomography - CT scan): This can clearly see the damage to the bones.
- MRI scan (Magnetic Resonance Imaging - MRI scan): This can best look for damage to the soft tissues of the spine, that is, the spinal cord and nerves.
How is Neurogenic Shock treated?
This is a medical emergency and treatment should begin immediately.
First, doctors will put a neck brace on your neck. This is to stop the spinal cord from getting worse, because moving your neck can make the injury worse.
Next, the most important thing is to control low blood pressure (hypotension). This is done by giving fluids like saline through an IV (intravenous).
Then, medication is given to control the slow heart rate (bradyarrhythmia).
While treating this 'Neurogenic Shock', you will also be treated for any other injuries you may have sustained from the accident.
What kind of medications are used?
Doctors may use several types of medications to manage neurogenic shock:
- Phenylephrine
- Norepinephrine `(Norepinephrine)`
- Epinephrine
- Atropine
- Glycopyrrolate `(Glycopyrrolate)`
- Isoproterenol `(Isoproterenol)`
- Theophylline
- Aminophylline
These medications are given under the strict supervision of a doctor, taking into account many factors such as the patient's condition, blood pressure, and heart rate.
Are there any complications or side effects of the treatment?
Any medication can cause side effects. But doctors only choose a medication if the benefit to the patient outweighs the risk. Also, if the amount of fluid given through the IV is sometimes too high, there is a small chance that the body will swell.
How can I reduce this risk?
Since the main cause of neurogenic shock is spinal cord injury, it is important to prevent such injuries. There are several things you can do to help:
- Do not drive under the influence of alcohol or drugs. Drive mindfully and attentively.
- Always wear a seat belt when riding in a car. Ride safely on three-wheelers and motorcycles.
- Do not go diving in unknown places or shallow water. This can cause serious neck injuries.
- Be careful about safety when climbing trees and working at heights.
What can I expect if I have neurogenic shock?
If a spinal cord injury causes neurogenic shock, low blood pressure (hypotension) can persist for up to five weeks.
Also, other complications can arise with this condition. For example:
- Blood clots in the veins of the legs (Deep Vein Thrombosis - DVT)
- Stress ulcers
- Aspiration pneumonia is caused by food or other objects getting into the airway .
How long can neurogenic shock last?
Typically, the symptoms of neurogenic shock can last for about four to five weeks . However, this can vary from person to person and depending on the nature of the accident.
Will I be able to go back to work/school?
Whether you can return to your normal activities, work, or school depends on the severity of your spinal cord injury and the nature of any other injuries you may have sustained. Sometimes you may need to make some big changes to your life, especially if you have difficulty walking.
What is the outlook for neurogenic shock?
If left untreated, most cases of shock are fatal. However, prompt and proper treatment can save your life. Your future health depends on several factors, including:
- your age.
- The severity of the accident.
- Damage to other organs.
- Other chronic diseases you have (other medical problems).
- How long did it take to get treatment?
- Additional problems such as inability to speak and loss of balance.
- How your body responds to treatment.
Sadly, someone who has had a spinal cord injury is two to five times more likely to die prematurely than someone who has not. The risk of death is highest in the first year after a spinal cord injury.
How do I take care of myself?
With a spinal cord injury, you are more likely to develop other health problems, such as Deep Vein Thrombosis (DVT), as mentioned earlier. Also, neurogenic shock, a condition in which blood flow is reduced and one or more organs are damaged.
Everyone's situation is different, but for anyone who has experienced neurogenic shock, it is important to follow physical therapy and medical advice carefully to prevent future problems.
When should I see my doctor?
If you notice any changes in your condition, such as changes in vital signs or pain, you should inform your doctor immediately.
When should I go to the Emergency Treatment Unit (ETU) ?
You should seek emergency treatment immediately if you have these symptoms:
- Chest pain
- Dizziness
- Nausea
These may be symptoms of another serious condition.
What questions should I ask my doctor?
You can ask the doctor questions like these:
- What is the outlook for my specific situation?
- Have my organs been damaged due to 'Neurogenic Shock'?
- What are the most important things I need to do given my situation?
Summary and Take-Home Message
Okay, so the 'Neurogenic Shock' we talked about today is a very dangerous condition that can occur due to a severe injury to the spinal cord. In this, the damage to the nervous system causes the body to lose control over things like heart rate and blood pressure.
The most important thing is to stay as safe as possible and try to avoid injuries to your spine. Be very careful when driving, working at heights, and jumping into water.
If an accident occurs, seeking immediate medical attention can help save your life. After that, continuing with physical therapy as directed by your doctor will help you stay as healthy as possible. Your medical team will help you overcome this challenge.
` Neurogenic Shock, Spinal Cord Injury, Blood Pressure, Nervous System, Emergency, Hypotension, Bradyarrhythmia
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