Which type of shock is classically associated with spinal cord injury and massive vasodilation?

• A. Neurogenic
• B. Hypovolemic
• C. Cardiogenic
• D. Septic

Answer: (A)

Massive vasodilation after a spinal cord injury is best understood through neurogenic shock, which occurs when the spinal injury disrupts the sympathetic nervous system’s control of blood vessels. Without sympathetic tone, vessels below the injury lose their constriction and dilate widely, causing a dramatic drop in systemic vascular resistance and blood pressure. The heart also loses sympathetic input, so heart rate can fall (bradycardia), which compounds the low blood pressure. Because the vasodilation is from autonomic failure rather than fluid loss, the skin can feel warm and dry rather than cool and clammy.

Other types of shock arise from different mechanisms: hypovolemic shock results from loss of circulating blood or fluids and typically presents with tachycardia and cool, clammy skin due to compensatory vasoconstriction. Cardiogenic shock stems from the heart’s inability to pump effectively, often with cool, moist skin and pulmonary congestion. Septic shock is infection-driven distributive shock, usually with fever and a progression from warm to cooler skin as it evolves, not specifically tied to spinal injury.

So, the classic association with spinal cord injury and widespread vasodilation is neurogenic shock.