Neurological Disorders Q 44 - Gyan Darpan : Learning Portal
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Tuesday, 19 April 2022

Neurological Disorders Q 44

A client with a T1 spinal cord injury arrives at the emergency department with a BP of 82/40, pulse 34, dry skin, and flaccid paralysis of the lower extremities. Which of the following conditions would most likely be suspected?
     A. Autonomic dysreflexia
     B. Hypervolemia
     C. Neurogenic shock
     D. Sepsis

Correct Answer: C. Neurogenic shock

Loss of sympathetic control and unopposed vagal stimulation below the level of injury typically cause hypotension, bradycardia, pallor, flaccid paralysis, and warm, dry skin in the client in neurogenic shock. Neurogenic shock is a devastating consequence of spinal cord injury (SCI), also known as vasogenic shock. Injury to the spinal cord results in a sudden loss of sympathetic tone, which leads to the autonomic instability that is manifested in hypotension, bradyarrhythmia, and temperature dysregulation.

Option A: Autonomic dysreflexia occurs after neurogenic shock abates. Neurogenic shock is defined as the injury to the spinal cord with associated autonomic dysregulation. This dysregulation is due to a loss of sympathetic tone and an unopposed parasympathetic response. Neurogenic shock is most commonly a consequence of traumatic spinal cord injuries.
Option B: Hypervolemia is indicated by rapid and bounding pulse and edema. The joint committee of the American Spinal Injury Association and the International Spinal Cord Society proposed the definition of a neurogenic shock to be general autonomic nervous system dysfunction that also includes symptoms such as orthostatic hypotension, autonomic dysreflexia, temperature dysregulation.
Option D: Signs of sepsis would include elevated temperature, increased heart rate, and increased respiratory rate. Though neurogenic shock should be considered only after a hemorrhagic shock has been ruled out in a traumatic patient, the presence of vertebral fracture or dislocation raises the concern for a neurogenic shock. Bradyarrhythmia, hypotension, flushed warm skin are the classic signs associated with neurogenic shock.

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