Endless hours of studying, relentless exams, and the never-ending confusion between two perplexing phenomena: spinal shock and neurogenic shock. So, buckle up (so you don’t end up in spinal shock) and prepare for the journey through the world of spinal and neurogenic shock as we break down their differences.
The Tale of Two ShocksPicture this: you’re in the ER, and a patient comes in with a recent spinal cord injury. You rack your brain to differentiate between spinal shock and neurogenic shock, but all you can remember is the cranial nerves mnemonic and your chief resident is about to pimp the you know what out of you… Let’s make it easy!
- Spinal Shock: Think of it as your body’s initial reaction to “breaking up” with your spinal cord. It’s a temporary and unexpected “break-up shock” that leaves your reflexes, motor function, and sensation feeling lost and numb (physically, not emotionally) below the level of injury.
- Neurogenic Shock: Now, imagine your body losing its balance between the sympathetic and parasympathetic nervous systems after a spinal cord injury. It’s like a tug-of-war, but the parasympathetic system wins, causing blood vessels to dilate and blood pressure to drop. Your heart, not knowing how to cope, slows down in response (bradycardia). Neurogenic shock occurs because the descending sympathetic fibers of the cord are injured, whereas the parasympathetic supply to the body provided by the vagus nerve (ie: “wandering nerve”) off of the brainstem is still intact and is now un-inhibited.
Diagnostic Dilemmas: The Hints are There You Just Have to Look
When you’re trying to diagnose spinal or neurogenic shock, look for these clues:
- Spinal Shock: Your patient’s reflexes have gone on vacation, and they’re not telling you when they’ll be back. The muscles are flaccid, and sensations are playing hide-and-seek. But fear not, because those reflexes will eventually return. The delayed plantar response and bulbocavernosus reflex (don’t ask us how someone figured this one out!) are two of the earlier reflexes to come back from vacation. There is a lot of debate about how to define spinal shock and how long spinal shock lasts. However, you cannot prognosticate about the severity of cord injury until at least one reflex has returned.
- Neurogenic Shock: Here, your patient’s blood pressure is lower than your motivation on a Monday morning, and their heart rate is slower than a sloth doing yoga. The skin may be warm and dry, resembling a cozy blanket you wish you were under instead of being in the ER.
Treatments: The Cures
Now that you’ve (hopefully) identified which shock you’re dealing with, it’s time to strategize and take action:
- Spinal Shock: When faced with this shock, channel your inner superhero and protect the injured spinal cord at all costs! Immobilize the spine, maintain blood pressure, and ensure proper oxygenation to minimize further damage. Neurosurgical consultation is often indicated if the spinal column is unstable and requires surgical fixation.
- Neurogenic Shock: Roll up your sleeves and get ready for some serious hemodynamic management. Rehydrate your patient with IV fluids, bring out the vasopressors to constrict those dilated blood vessels, and, if necessary, consider a temporary pacemaker to speed up the slow-motion heart rate.
Remember that both neurogenic and spinal shock are often occuring at the same time! Additionally, remember that neurogenic shock can also co-exist with other types of shock like hypovolemic shock in polytrauma patients.
As future health practitioners, you’ll face many confusing and challenging scenarios, like differentiating between spinal shock and neurogenic shock. But remember, amidst the stress, it’s essential to find some humor and light-heartedness. After all, laughter is the best medicine, and knowing the difference between these two conditions will not only help your patients, but also save you from those embarrassing moments during rounds. So, hold your head high, and step into the world of medicine with a smile on your face and the ability to distinguish between spinal and neurogenic shock in your ever-expanding medical knowledge toolbox.
More Fun Spinal Cord Pathology
- Cervical Facet Dislocation: Houston We Have a Problem
- Denis’ Three Column Spine: A Simple Way to Think About Spinal Stability
- Atlas Fracture: The Weight of the World on Its Shoulders
- Cervical Myelopathy: A Squished Spinal Cord
References and Resources
- Ko HY. Revisit Spinal Shock: Pattern of Reflex Evolution during Spinal Shock. Korean J Neurotrauma, 2018.
- Kirshblum S, Lin V. Spinal Cord Medicine: Comprehensive Evidence-Based Clinical Reference for Diagnosis and Treatment of Spinal Cord Injuries and Conditions Third Edition.