Spinal shock

Background

• Do not confuse with Neurogenic Shock
• Transient stunning of the cord with global loss of function (unlike neurogenic shock) with temporary loss of spinal cord function below complete or incomplete spinal cord injury
  • Flaccid paralysis, anesthesia, absent bowel/bladder control and reflex activity, priapism
  • Can make an incomplete lesion appear as complete
    • Cord lesions cannot be deemed complete until spinal shock has resolved
• Can think of it as a "concussion" of the spinal cord

Clinical Features

• Bulbocavernosus reflex is among the first to return as spinal shock resolves
  • Performed by squeezing glans of penis or clitoris and monitoring for anus contraction
  • Mediated by S2-S4
• Usually lasts day to weeks
  • Resolves when soft tissue swelling improves

Differential Diagnosis

Shock

• Cardiogenic
  • Acute valvular Regurgitation/VSD
  • CHF
  • Dysrhythmia
  • ACS
  • Myocardial Contusion
  • Myocarditis
  • Drug toxicity (e.g. beta blocker, CCB, or bupropion OD)
• Obstructive
  • Air embolism
  • Aortic Stenosis
  • Cardiac Tamponade
  • PE
  • Tension pneumothorax
• Distributive
  • Adrenal crisis
  • Anaphylaxis
  • Neurogenic shock
  • Sepsis
  • Toxicologic
• Hypovolemic
  • Severe dehydration
  • Hemorrhagic shock (traumatic and non-traumatic)

Disposition

• Admission

See Also

• Spinal Cord Trauma
• Spinal Cord Compression (Non-Traumatic)
• Neurogenic Shock