From the Research
Yes, neurogenic shock can cause flaccid paralysis. Neurogenic shock occurs when there is damage to the spinal cord, particularly at T6 level or above, disrupting the sympathetic nervous system pathways. This disruption leads to loss of sympathetic tone, causing vasodilation, hypotension, and bradycardia. When the spinal cord injury affects motor pathways, it can result in flaccid paralysis below the level of injury. This flaccidity occurs because the injury interrupts the normal transmission of signals from the brain to the muscles, leading to loss of muscle tone and reflexes. In the acute phase following spinal cord injury, this presents as flaccid paralysis with areflexia (absence of reflexes) 1.
Key Points to Consider
- The incidence of neurogenic shock varies depending on the level of spinal cord injury, with higher incidence in cervical cord injuries 2.
- Neurogenic shock can present in the prehospital environment and without warning in a patient with previously normal vital signs 1.
- Management involves addressing both the cardiovascular effects of neurogenic shock (with fluids and vasopressors like norepinephrine) and providing appropriate care for the paralysis through positioning, physical therapy, and prevention of complications like pressure ulcers and deep vein thrombosis 3.
- The use of midodrine and fludrocortisone may be beneficial in managing neurogenic shock, as seen in a case report where these medications helped to taper off vasopressor therapy 3.
Clinical Implications
- It is essential to be aware of the potential for neurogenic shock in all patients with spinal cord injury, regardless of the level of injury 1.
- Early recognition and management of neurogenic shock are crucial to prevent complications and improve outcomes 4.
- A comprehensive approach to managing neurogenic shock, including cardiovascular support and care for the paralysis, is necessary to optimize patient outcomes 5.