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Neurogenic Shock

Aka: Neurogenic Shock

See Also
1. Spinal Shock
2. Hemorrhagic Shock
Pathophysiology
1. Results from severe Head Injury
2. Peripheral sympathetic denervation (ungoverned parasympathetic activity)
Signs
1. Hypotension
  1. Secondary to Bradycardia and vasodilation
2. Bradycardia
3. Decreased vascular tone (vasodilation)
  1. Warm extremities
Differential Diagnosis
1. Hemorrhagic Shock (first priority to manage)
  1. Presents with Tachycardia, Vasoconstriction and cold extremities
  2. In actuality, distinguishing from Neurogenic Shock can be difficult
  3. Hemorrhagic Shock is more common, more immediately deadly and more treatable and should be addressed first
Pitfalls
1. Fluid Overload (from aggressive fluid Resuscitation)
Management
1. Careful fluid replacement
2. Pressors (Norepinephrine is preferred)
3. Target mean arterial pressure of 85 mmHg or higher (maximizes spinal cord perfusion)
Prognosis
1. Neurogenic Shock is a critcial Head Injury to the point of terminal event
2. Prognosis is often poor

Family Practice Notebook

Patients should address specific medical concerns with their physicians.

Although access to this page is not restricted, the information found here is intended for use by medical providers.

This page was written by Scott Moses, MD, last revised on 1/6/2012 and last published on 5/10/2012.

This is one of 5737 pages in the Family Practice Notebook