Neurogenic shock is a condition when blood cannot flow normally to body tissues due to damage to the nervous system. Left unchecked, neurogenic shock can be fatal. Therefore, early identification and prompt treatment are urgently needed.
Neurogenic shock, also known as vasogenic shock, generally 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 respiration.
If the sympathetic nervous system cannot function properly, blood pressure in the body can suddenly drop dramatically ( shock ) so that blood circulation throughout the body is 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 interference with sympathetic function. The sympathetic nervous system functions to amplify the heartbeat, increase blood pressure and flow, and widen the respiratory tract.
When the sympathetic nervous system is not functioning, blood vessels dilate so they cannot push blood flow throughout the body. This causes a drop 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. This 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 occurs
- Secondary spinal cord injury, which is damage to the nervous system that occurs hours or days after the injury
Apart from spinal cord injuries, several other conditions or diseases that can also cause neurogenic shock are:
- Use of drugs that affect sympathetic nerve function
- Lack of oxygen in the brain, for example due to stroke
- Subarachnoid hemorrhage
- Meningitis (inflammation of the lining of the brain)
Although very rare, neurogenic shock can also occur as a result of seizures in epilepsy, Guillain-Barre syndrome , and brain hernias. Some procedures close to the spine, such as surgery or anesthetic administration, can also cause neurogenic shock.
Symptoms of Neurogenic Shock
Neurogenic shock is an emergency condition characterized by a concomitant decrease in vital signs, namely:
- Decreased blood pressure (systolic pressure <100 mmHg)
- Decreased heart rate (pulse <60 beats per minute)
- Decreased body temperature (temperature <36.5 o C)
These signs are usually followed by the following symptoms:
- Blank stare
- Excessive sweating
- pale skin
In more severe conditions, sufferers may also experience other symptoms, such as:
- Hard to breathe
- Chest pain
- Blue lips and fingers ( cyanosis )
- The pulse is hard to feel
When to see a doctor
Seek immediate medical attention if you experience the symptoms of neurogenic shock as mentioned above, for example if you have an injury to your spine accompanied by nausea or dizziness, and chest pain.
It's important to remember, don't wait for the symptoms to get worse. Neurogenic shock is a dangerous condition and can be fatal, so early treatment is needed.
Diagnosis of Neurogenic Shock
Neurogenic shock is an emergency condition that must be treated immediately to avoid fatal consequences. Diagnosis is made quickly by asking for a history before shock occurs and quickly checking vital signs. After that, emergency treatment will be carried out until the patient's condition is stable.
After the patient's condition is stable, the doctor will carry out supporting examinations to find out 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
Treatment of Neurogenic Shock
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 making the patient immobile at all. This aims to prevent further damage to the nervous system.
If needed, the doctor will take the following steps:
- Place support on 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 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 damage to the injured spinal cord.
Neurogenic Shock Complications
Neurogenic shock can cause permanent damage to organs or body tissues that don't get enough blood supply. This can occur simultaneously in all organs so that it can cause death.
Prevention of Neurogenic Shock
The best way to prevent neurogenic shock from occurring is to avoid its 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 drowsy
- Always check the water depth before jumping into the water
- Avoid the risk of falling
- Take care when exercising, for example by using proper protection