Neurological and Spinal Shock are Often Confused but They’re not the Same!
Neurological Shock vs. Spinal Shock: What is the Difference?
Introduction
Neurological shock and spinal shock are terms often used interchangeably, but they’re not the same! The terms represent two distinct phenomena. Let’s have a look at the differences, and their clinical relevance.
Neurological Shock
Definition: Neurological shock (aka: Neurogenic Shock) is a hemodynamic syndrome that results from a sudden loss of autonomic tone due to spinal cord injury. These are usually “high” on the spine, above T6 and these injuries cause an autonomic blockade. The loss of sympathetic response causes a reduction in the levels of catecholamines.
Hemodynamic Changes: Spinal cord damage leads to autonomic nervous system disruption: The failure of the autonomic nervous system leads to inappropriate hypotension and bradycardia secondary to the reduction of catecholamines. The chronotropic and vasoconstrictive effects are lost.
Neurological shock is fundamentally circulatory in nature, affecting perfusion and hemodynamic stability. It presents as profound hypotension and bradycardia.
Spinal Shock
Definition: Spinal shock, on the other hand, only becomes apparent with a thorough neurologic examination following an acute spinal cord injury. In these cases, the bleeding, inflammation and chemical mediators conspire to cause ischemia of the spinal cord itself.
Temporary Loss of Reflexes and Muscle Tone: Spinal shock is a temporary loss of reflexes and muscle tone below the level of the spinal cord injury.
Flaccid Areflexia: Patients affected by spinal shock exhibit flaccid areflexia, meaning their reflexes are absent or significantly diminished.
Duration: Spinal shock can last from hours to weeks, depending on the severity of the injury and the subsequent healing process. As secondary injury factors (such as swelling) resolve, spinal shock may gradually improve.
Differential Diagnoses
Neurological shock is characterized by hemodynamic changes, while spinal shock is a syndrome of neurologic deficits.
Duration: It is possible to compensate for neurological shock in the short term if it is recognized and treated, whereas spinal shock might persist for days to weeks.
Clinical Presentation: Neurological shock presents with hemodynamic instability, whereas spinal shock primarily affects reflexes and muscle tone.
Treatment Approach: Managing neurological shock involves stabilizing blood pressure and heart rate, usually with crystalloids and atropine. Treatment of spinal shock focuses on supportive care during the recovery phase.
Conclusion
Neurological shock refers to a hemodynamic problem, while spinal shock involves neurologic deficits. By understanding these distinctions, healthcare professionals can navigate the complexities of spinal cord injuries more effectively, ultimately improving patient outcomes.
References:
- Conti, K., Yellapu, V., Sweeney, J., Falowski, S. M., & Stawicki, S. P. (2020). Spinal Shock: Differentiation from Neurogenic Shock and Key Management Approaches. IntechOpen1
- ScienceDirect. (2020). Spinal Shock: What It Is and How You Treat It2
- SpringerLink. (2021). Spinal Shock: Definition and Clinical Implications3
- Springer. (2023). Spinal Shock: Understanding the Phenomenon and Reflex Changes4
