What characterizes neurogenic shock after spinal cord injury?

• A. Hypotension and bradycardia due to loss of sympathetic tone, with warm dry skin
• B. Hypertension and tachycardia due to sympathetic overactivity
• C. Fever and dehydration
• D. Seizures with posturing

Answer: (A)

Neurogenic shock after spinal cord injury arises when the descending sympathetic pathways are disrupted. Without sympathetic outflow, there is widespread vasodilation which lowers systemic vascular resistance and drops blood pressure. At the same time, the heart is left under unopposed parasympathetic (vagal) influence, leading to bradycardia. Because the sympathetic effect on skin vessels is lost, the skin becomes warm and dry rather than cool and clammy. This combination—hypotension with bradycardia and warm, dry skin—best characterizes the condition. Hypertension with tachycardia would suggest sympathetic overactivity, fever and dehydration point to other processes, and seizures with posturing indicate a different neurologic problem altogether.