Download PDF
CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2018; 37(03): 196-205
DOI: 10.1055/s-0036-1584887
Review Article | Artigo de Revisão
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Neurogenic Shock: Clinical Management and Particularities in an Emergency Room

Article in several languages: English | português
Daniel Damiani
1   Department of Neuroscience, Universidade Anhembi Morumbi, São Paulo, SP, Brazil
› Author Affiliations
Further Information

Publication History

13 April 2016

10 May 2016

Publication Date:
25 October 2016 (online)

Also available at
   Permissions and Reprints

Abstract

Neurogenic shock has a strong impact in traumatology. It is an important condition, associated with lesions in the neuraxis and can be medullar and/or cerebral. In the last years, its pathophysiology has been better understood, allowing a reduction in the morbimortality with more precise and efficacious interventions taking place in the emergency room. In this review article, the author presents the current aspects of the management of neurogenic shock, highlighting the neuroprotective measures that improve the outcome. Many pharmacologic interventions are still questionable and need more prospective studies to accurately assess their real value. The best moment for neurosurgical intervention is also debatable. Quite clearly, the initial proceedings in the emergency room are fundamental to guarantee the adequate conditions for neuroplasticity and neuronal rehabilitation.

Keywords

neurogenic shock - spinal shock - intensive care - spinal cord injury - head trauma - neurotrauma
 

  • References

  • 1 Popa C, Popa F, Grigorean VT. , et al. Vascular dysfunctions following spinal cord injury. J Med Life 2010; 3 (03) 275-285
    PubMedSearch in Google Scholar
  • 2 Grigorean VT, Sandu AM, Popescu M. , et al. Cardiac dysfunctions following spinal cord injury. J Med Life 2009; 2 (02) 133-145
    PubMedSearch in Google Scholar
  • 3 Furlan JC, Fehlings MG. Cardiovascular complications after acute spinal cord injury: pathophysiology, diagnosis, and management. Neurosurg Focus 2008; 25 (05) E13
    CrossrefPubMedSearch in Google Scholar
  • 4 Casha S, Christie S. A systematic review of intensive cardiopulmonary management after spinal cord injury. J Neurotrauma 2011; 28 (08) 1479-1495
    CrossrefPubMedSearch in Google Scholar
  • 5 Vincent JL, De Backer D. Circulatory shock. N Engl J Med 2013; 369 (18) 1726-1734
    Search in Google Scholar
  • 6 Coleman WP, Benzel D, Cahill DW. , et al. A critical appraisal of the reporting of the National Acute Spinal Cord Injury Studies (II and III) of methylprednisolone in acute spinal cord injury. J Spinal Disord 2000; 13 (03) 185-199
    CrossrefPubMedSearch in Google Scholar
  • 7 Bracken MB, Shepard MJ, Holford TR. , et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA 1997; 277 (20) 1597-1604
    CrossrefPubMedSearch in Google Scholar
  • 8 Hurlbert RJ. Methylprednisolone for acute spinal cord injury: an inappropriate standard of care. J Neurosurg 2000; 93 (1, Suppl) 1-7
    PubMedSearch in Google Scholar
  • 9 Hector SM, Biering-Sørensen T, Krassioukov A, Biering-Sørensen F. Cardiac arrhythmias associated with spinal cord injury. J Spinal Cord Med 2013; 36 (06) 591-599
    CrossrefPubMedSearch in Google Scholar
  • 10 Krishna V, Andrews H, Varma A, Mintzer J, Kindy MS, Guest J. Spinal cord injury: how can we improve the classification and quantification of its severity and prognosis?. J Neurotrauma 2014; 31 (03) 215-227
    CrossrefPubMedSearch in Google Scholar
  • 11 Yılmaz T, Kaptanoğlu E. Current and future medical therapeutic strategies for the functional repair of spinal cord injury. World J Orthop 2015; 6 (01) 42-55
    CrossrefPubMedSearch in Google Scholar
  • 12 Kaptanoglu E, Sen S, Beskonakli E. , et al. Antioxidant actions and early ultrastructural findings of thiopental and propofol in experimental spinal cord injury. J Neurosurg Anesthesiol 2002; 14 (02) 114-122
    CrossrefPubMedSearch in Google Scholar
  • 13 Kaptanoglu E, Tuncel M, Palaoglu S, Konan A, Demirpençe E, Kilinç K. Comparison of the effects of melatonin and methylpredniso- lone in experimental spinal cord injury. J Neurosurg 2000; 93 (01) , Suppl) 77-84
    CrossrefPubMedSearch in Google Scholar
  • 14 Kaptanoglu E, Solaroglu I, Okutan O, Surucu HS, Akbiyik F, Beskonakli E. Erythropoietin exerts neuroprotection after acute spinal cord injury in rats: effect on lipid peroxidation and early ultrastructural findings. Neurosurg Rev 2004; 27 (02) 113-120
    CrossrefPubMedSearch in Google Scholar
  • 15 Hagen EM. Acute complications of spinal cord injuries. World J Orthop 2015; 6 (01) 17-23
    CrossrefPubMedSearch in Google Scholar
  • 16 Ditunno JF, Little JW, Tessler A, Burns AS. Spinal shock revisited: a four-phase model. Spinal Cord 2004; 42 (07) 383-395
    CrossrefPubMedSearch in Google Scholar
  • 17 Guly HR, Bouamra O, Lecky FE. ; Trauma Audit and Research Network. The incidence of neurogenic shock in patients with isolated spinal cord injury in the emergency department. Resuscitation 2008; 76 (01) 57-62
    CrossrefPubMedSearch in Google Scholar
  • 18 Karlsson AK. Autonomic dysfunction in spinal cord injury: clinical presentation of symptoms and signs. Prog Brain Res 2006; 152: 1-8
    CrossrefPubMedSearch in Google Scholar
  • 19 Davison DL, Terek M, Chawla LS. Neurogenic pulmonary edema. Crit Care 2012; 16 (02) 212-219
    CrossrefPubMedSearch in Google Scholar
  • 20 Davison DL, Chawla LS, Selassie L, Tevar R, Junker C, Seneff MG. Neurogenic pulmonary edema: successful treatment with IV phentolamine. Chest 2012; 141 (03) 793-795
    CrossrefPubMedSearch in Google Scholar
  • 21 Mrozek S, Constantin JM, Geeraerts T. Brain-lung crosstalk: Implications for neurocritical care patients. World J Crit Care Med 2015; 4 (03) 163-178
    PubMedSearch in Google Scholar
  • 22 Summers RL, Baker SD, Sterling SA, Porter JM, Jones AE. Characterization of the spectrum of hemodynamic profiles in trauma patients with acute neurogenic shock. J Crit Care 2013; 28 (04) 531.e1-531.e5
    CrossrefPubMedSearch in Google Scholar
  • 23 Kool DR, Blickman JG. Advanced Trauma Life Support. ABCDE from a radiological point of view. Emerg Radiol 2007; 14 (03) 135-141
    CrossrefPubMedSearch in Google Scholar
  • 24 Tee JW, Chan CHP, Fitzgerald MCB, Liew SM, Rosenfeld JV. Epidemiological trends of spine trauma: an Australian level 1 trauma centre study. Global Spine J 2013; 3 (02) 75-84
    Thieme ConnectPubMedSearch in Google Scholar
  • 25 Sundstrøm T, Asbjørnsen H, Habiba S, Sunde GA, Wester K. Prehospital use of cervical collars in trauma patients: a critical review. J Neurotrauma 2014; 31 (06) 531-540
    CrossrefPubMedSearch in Google Scholar
  • 26 Chak Wah K, Wai Man C, Janet Yuen Ha W, Lai V, Kit Shing John W. Evolving frontiers in severe polytrauma management - refining the essential principles. Malays J Med Sci 2013; 20 (01) 1-12
    PubMedSearch in Google Scholar
  • 27 Mutschler M, Nienaber U, Wafaisade A. , et al; TraumaRegister DGU®. The impact of severe traumatic brain injury on a novel base deficit- based classification of hypovolemic shock. Scand J Trauma Resusc Emerg Med 2014; 22: 28-34
    CrossrefPubMedSearch in Google Scholar
  • 28 Mutschler M, Nienaber U, Brockamp T. , et al; TraumaRegister DGU. A critical reappraisal of the ATLS classification of hypovolaemic shock: does it really reflect clinical reality?. Resuscitation 2013; 84 (03) 309-313
    CrossrefPubMedSearch in Google Scholar
  • 29 Woller SA, Hook MA. Opioid administration following spinal cord injury: implications for pain and locomotor recovery. Exp Neurol 2013; 247: 328-341
    CrossrefPubMedSearch in Google Scholar
  • 30 Myburgh JA, Mythen MG. Resuscitation fluids. N Engl J Med 2013; 369 (13) 1243-1251
    CrossrefPubMedSearch in Google Scholar
  • 31 Chatrath V, Khetarpal R, Ahuja J. Fluid management in patients with trauma: Restrictive versus liberal approach. J Anaesthesiol Clin Pharmacol 2015; 31 (03) 308-316
    CrossrefPubMedSearch in Google Scholar
  • 32 De Backer D, Creteur J, Dubois MJ. , et al. The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects. Crit Care Med 2006; 34 (02) 403-408
    CrossrefPubMedSearch in Google Scholar
  • 33 Adams Jr HP, del Zoppo G, Alberts MJ. , et al; American Heart Association/American Stroke Association Stroke Council; American Heart Association/American Stroke Association Clinical Cardiology Council; American Heart Association/American Stroke Association Cardiovascular Radiology and Intervention Council; Atherosclerotic Peripheral Vascular Disease Working Group; Quality of Care Outcomes in Research Interdisciplinary Working Group. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation 2007; 115 (20) e478-e534
    PubMedSearch in Google Scholar
  • 34 Ickenstein GW, Riecker A, Höhlig C. , et al. Pneumonia and in-hospital mortality in the context of neurogenic oropharyngeal dysphagia (NOD) in stroke and a new NOD step-wise concept. J Neurol 2010; 257 (09) 1492-1499
    CrossrefPubMedSearch in Google Scholar
  • 35 Wohns RN, Tamas L, Pierce KR, Howe JF. Chlorpromazine treatment for neurogenic pulmonary edema. Crit Care Med 1985; 13 (03) 210-211
    CrossrefPubMedSearch in Google Scholar
  • 36 Lord JM, Midwinter MJ, Chen YF. , et al. The systemic immune response to trauma: an overview of pathophysiology and treatment. Lancet 2014; 384 (9952): 1455-1465
    CrossrefPubMedSearch in Google Scholar
  • 37 Cengiz SL, Kalkan E, Bayir A, Ilik K, Basefer A. Timing of thoracolomber spine stabilization in trauma patients; impact on neurological outcome and clinical course. A real prospective (rct) randomized controlled study. Arch Orthop Trauma Surg 2008; 128 (09) 959-966
    CrossrefPubMedSearch in Google Scholar
  • 38 Furlan JC, Noonan V, Cadotte DW, Fehlings MG. Timing of decompressive surgery of spinal cord after traumatic spinal cord injury: an evidence-based examination of pre-clinical and clinical studies. J Neurotrauma 2011; 28 (08) 1371-1399
    CrossrefPubMedSearch in Google Scholar
  • 39 Fouad K, Tse A. Adaptive changes in the injured spinal cord and their role in promoting functional recovery. Neurol Res 2008; 30 (01) 17-27
    CrossrefPubMedSearch in Google Scholar
  • 40 Onifer SM, Smith GM, Fouad K. Plasticity after spinal cord injury: relevance to recovery and approaches to facilitate it. Neurotherapeutics 2011; 8 (02) 283-293
    CrossrefPubMedSearch in Google Scholar
  • 41 Bracken MB, Shepard MJ, Collins WF. , et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med 1990; 322 (20) 1405-1411
    CrossrefPubMedSearch in Google Scholar
  • 42 Kwon BK, Okon E, Hillyer J. , et al. A systematic review of non-invasive pharmacologic neuroprotective treatments for acute spinal cord injury. J Neurotrauma 2011; 28 (08) 1545-1588
    CrossrefPubMedSearch in Google Scholar
  • 43 Wang J, Pearse DD. Therapeutic hypothermia in spinal cord injury: the status of its use and open questions. Int J Mol Sci 2015; 16 (08) 16848-16879
    CrossrefPubMedSearch in Google Scholar