Differentiating spinal and neurogenic shock and outlining management implications.

• A. Spinal shock is transient loss of spinal reflexes below injury with flaccidity; neurogenic shock is vasodilation with hypotension and bradycardia due to autonomic disruption; management: spinal shock supportive; neurogenic shock with fluids and vasopressors; maintain temperature
• B. Spinal shock is permanent; neurogenic shock is self-limiting; management is observation
• C. Spinal shock occurs with only head injury; neurogenic shock occurs with leg injury; management is surgery
• D. Spinal shock requires immediate antibiotics; neurogenic shock requires steroids

Answer: (A)

The key idea is that spinal shock and neurogenic shock arise from spinal cord injury but have different mechanisms and treatment approaches. Spinal shock is a temporary suppression of reflexes and tone below the injury, leading to flaccidity and absent reflexes. It’s a reversible, evolving process—the reflexes and some muscle tone often return over days to weeks as the spinal cord edema resolves, though the exam can be misleading early on because motor and sensory findings may look worse before they improve. The management is supportive: protect the airway and breathing, stabilize the spine, monitor neuro status, and support circulation as needed while waiting for reflexes to return.

Neurogenic shock, by contrast, is a hemodynamic problem from loss of sympathetic tone, usually when the injury is high enough (often above T6). It causes vasodilation, hypotension, and often bradycardia due to unopposed parasympathetic activity. Skin can be warm and dry from vasodilation. Management focuses on restoring and maintaining adequate perfusion to the spinal cord: use vasopressors (for example, norepinephrine or phenylephrine) and carefully guided fluid resuscitation to maintain MAP, while also preventing hypothermia and treating bradycardia if it’s symptomatic.

So the best match states that spinal shock is a transient loss of reflexes with flaccidity below the injury, neurogenic shock is vasodilation with hypotension and bradycardia from autonomic disruption, and management is supportive for spinal shock versus fluids and vasopressors (with temperature maintenance) for neurogenic shock.