Phases of spinal shock
| Phase | Time | Physical exam finding | Underlying physiological event |
| 1 | 0–1d | Areflexia / Hyporeflexia | Loss of descending facilitation |
| 2 | 1–3d | Initial reflex return | Denervation supersensitivity |
| 3 | 1–4w | Hyperreflexia (initial) | Axon-supported synapse growth |
| 4 | 1–12m | Hyperreflexia, Spasticity | Soma-supported synapse growth |
What is Spinal shock and what are the symptoms?
Sudden, temporary loss of sensory and motor functions below the level of spinal cord injury is referred to as a spinal shock. It is characterized by decreased blood pressure, increases sweating, nausea, etc. It shows the patient is going in a shocking state. Signs & Symptoms of Spinal Shock
What is Spinal shock and how is it treated?
Spinal shock describes the temporary loss of all reflexes, sensation, and motor control below one’s level of spinal cord injury. Often, it isn’t until spinal shock subsides that individuals develop a better understanding of what functions are or are not affected by spinal cord injury (SCI).
Can a spinal cord injury cause shock?
Although there are general symptoms (such as those listed previously), you cannot predict the kind of reaction an individual’s body will take following a spinal cord injury. Consequently, treatment for spinal shock tends to focus on treating the spinal cord injury as a whole.
How long does it take to recover from spinal shock?
This "shock" does not imply a state of circulatory collapse but of suppressed spinal reflexes below the level of cord injury. It takes between days and months for spinal shock to completely resolve and when it does, the flaccidity that was once seen gradually becomes spasticity.
What are symptoms of spinal shock?
Symptoms of Spinal ShockAltered body temperature.Skin color and moisture changes (such as dry and pale skin)Abnormal perspiration function (decreased or increased sweating, flushing)Increased blood pressure and slowed heart rate.Irregularities in the musculoskeletal system.Altered sensory response.More items...
What is a spinal shock?
The term “spinal shock” applies to all phenomena surrounding physiologic or anatomic transection of the spinal cord that results in temporary loss or depression of all or most spinal reflex activity below the level of the injury.
How long does spinal shock last for?
Spinal shock usually lasts for days or weeks after spinal cord injury and the average duration is 4 to 12 weeks. Spinal shock is terminated earlier and the pyramidal tract signs and defense reactions occur sooner in incomplete lesions than with complete transverse lesions.
Do you recover from spinal shock?
Spinal shock can persist from days to weeks, but typically resolves around 4-6 weeks after which functions may gradually start to return.
What is spinal shock?
Spinal shock is characterized by a temporary rise in blood pressure that is proceeded by hypotension, flaccid paralysis, urinary retention and fecal incontinence. If reversal of symptoms does not occur within 24hrs, it may call for protracted recovery time and lengthened stay in rehabilitation . YouTube. Em Quattrocchi.
What is spinal shock syndrome?
Overview. Also known as spinal shock syndrome, spinal shock is the loss of muscle tone and spinal reflexes below the level of a severe spinal cord lesion. This "shock" does not imply a state of circulatory collapse but of suppressed spinal reflexes below the level of cord injury.
What is neurogenic shock?
Neurogenic shock may occur in spinal cord injuries above T6, from the loss of autonomic innervation from the brain. In cervical and high thoracic SCI lesions, the synergy between sympathetic and parasympathetic system is lost but the parasympathetic system is preserved.
When reflexes return, do they follow a pattern?
When reflexes return, they follow a pattern where superficial ones show up before deep tendon reflexes [9].
Can spinal shock be prevented?
While spinal shock may not be easily prevented , it can be managed and often requires a multidisciplinary team effort to do so. Its understanding and that of its mechanisms will enable the application of interventions that will facilitate recovery.
Can a traumatic SCI occur in non-traumatic cord lesions?
Frequently follows a traumatic SCI[6], but may also occur in non-traumatic cord lesions[7]
Does spinal shock occur abruptly?
The resolution of spinal shock does not occur abruptly but in phases. Ditunno et al (2004)[12]proposed a four-phase model of the syndrome.
What is spinal shock?
First defined in the 1700s, spinal shock is a loss of reflexes that occurs within minutes of a SCI. How severe it is will depend on the extent of the SCI. There are four common stages of spinal shock that typically occur following an injury to the spinal cord.
How long does it take for a spinal shock to set in?
Patients may notice a full or partial loss of spinal cord reflexes in the affected area. These initial symptoms start to develop soon after the SCI happens, although it may take several hours for the full effects of spinal shock to set in.
What reflexes do you have to have to recover from spinal shock?
As recovery from spinal shock continues, delayed plantar reflexes that usually respond to foot stimulation and bulbocavernosus reflexes may return next. The bulbocavernosus reflex is also what doctor’s may test to determine the extent of spinal shock.
What is it called when a patient's nervous system is twitching?
Patients at this stage may twitch involuntarily or become spastic. This reaction is referred to as hyperreflexia. While it may seem odd or disturbing when it occurs, it’s a positive sign of nervous system healing.
Can reflexes return to normal after SCI?
Reflexes begin to return to normal at this point. How well reflexes are able to get back to normal depends on the extent of the SCI. It’s possible to have a loss of sensation in some parts of the body from the SCI and the return of some reflex reactions. Spinal shock is often left to heal on its own since doctors are more focused on treating ...
Is the human spine susceptible to trauma?
The human spine is a remarkable creation, but it’s still susceptible to damage from some type of trauma, as may be the case with a spinal cord injury (SCI). When a SCI does occur, the body reacts with what’s known as spinal shock.
Can spinal shock heal itself?
Treatment for spinal shock may include decompression or spinal fusion surgery. Beverly Hills patients with SCIs must remember that a damaged spinal cord can’t heal itself.
What are the symptoms of spinal shock?
Emergency signs and symptoms of spinal shock after spinal cord injury include. Weakness and paralysis in any part of your body below the level of L3-L4 level. Numbness, loss of sensation, and tingling in your hands, face, toes, or feet. Decrease blood pressure.
What is spinal shock?
Spinal shock refers to a clinical syndrome associated with the loss of autonomic tone leading to hypothermia, hypothermia, and ileus below the level of spinal cord injury. It is characterized by loss of sensory and motor functions and loss of reflexes. When does it happen?
How Will You Diagnosed Your Patient Have Spinal Shock?
When the spinal is given in a sitting position, the patient looks vitally stable. Spinal shock develops suddenly within a few minutes or hours.
What is neurogenic shock?
Neurogenic Shock: It refers to hemodynamic changes resulting in loss of reflex and loss of autonomic tone after the spinal cord injury. Whereas the loss of sensation after the spinal cord injury is referred to as Spinal Shock. The anesthetic should keep monitoring the patient’s vitals and facial expressions to promptly diagnosed the symptoms ...
What level of anesthesia is used for spinal surgery?
All the patients who have to undergo the surgeries below the abdomen must have taken spinal anesthesia. Spinal anesthesia is given at the level of L3-L4, (at the midpoint of two anterior iliac spines). Bupivacaine is used in spinal anesthesia to block the nerve and decrease the feeling in that area.
When spinal cord injury is given in a sitting position, the patient looks vitally stable?
Sudden, temporary loss of sensory and motor functions below the level of spinal cord injury is referred to as a spinal shock .
Can spinal cord injury be treated?
There is no proper medication to treat or regenerate the damaged portion of the spinal cord. Spinal cord injury is an irreversible loss. Though immediate intervention can prevent further complications of spinal injury like permanent loss of bladder and bowel control, muscle tone, pain, sexual health, and depression.
What Happens To The Patient In The Different Stages of Spinal Shock?
Stage 1 of Spinal Shock: In this phase, there is weakening or complete loss of all reflexes below the level of spinal cord injury. This phase lasts for a day.
What Are The Causes of Spinal Shock?
The injury leading to spinal shock can occur as a result of motor vehicle accidents, penetrating injuries and accident at work place and even domestic accidents.
What is spinal cord injury?
Spinal cord injury causes sensory, motor and autonomic nerve damage. Spinal shock or Spinal cord shock is a combination of autonomic and motor dysreflexia.
What is neurogenic shock?
Neurogenic shock is caused by severe autonomic dysfunction or dysreflexia resulting in severe vasodilatation and heart malfunction. 2 Neurogenic shock may not be associated with areflexia. Spinal shock does cause minor transient autonomic dysfunction. Patient enters spinal shock within a few minutes after the spinal cord injury; however, ...
What is the second stage of spinal shock?
Stage 2 of Spinal Shock: This stage occurs over the next two days and there is gradual return of some of the reflexes below the spinal cord injury.
How long does spinal shock last?
The duration of spinal shock can be anywhere from 4 to 6 weeks after the injury. Rarely, spinal shock can last for some months. The absence of reflexes or signals hampers the patient’s ability to move, ability to feel and other functions.
Why does injury result in hypotension?
Injury results in hypotension because of dilatation of all the blood vessels in chest, abdomen and lower leg.
What is spinal shock?
The 'shock' in spinal shock does not refer to circulatory collapse, and should not be confused with neurogenic shock, which is life-threatening.
When was spinal shock first discovered?
Spinal shock was first explored by Whytt in 1750 as a loss of sensation accompanied by motor paralysis with initial loss but gradual recovery of reflexes, following a spinal cord injury (SCI) – most often a complete transection.
What happens if you have a spinal cord injury above T6?
In spinal cord injuries above T6, neurogenic shock may occur, from the loss of autonomic innervation from the brain. Parasympathetic is preserved but the synergy between sympathetic and parasympathetic system is lost in cervical and high thoracic SCI lesions. Sacral parasympathetic loss may be encountered in lesions below T6 or T7. Cervical lesions cause total loss of sympathetic innervation and lead to vasovagal hypotension and bradyarrhythmias – which resolve in 3–6 weeks. Autonomic dysreflexia is permanent, and occurs from Phase 4 onwards. It is characterized by unchecked sympathetic stimulation below the SCI (from a loss of cranial regulation), leading to often extreme hypertension, loss of bladder or bowel control, sweating, headaches, and other sympathetic effects.
What is phase 1 of the SCI?
Phase 1 is characterized by a complete loss—or weakening—of all reflexes below the SCI. This phase lasts for a day. The neurons involved in various reflex arcs normally receive a basal level of excitatory stimulation from the brain.
Why do reflexes return?
The reason reflexes return is the hypersensitivity of reflex muscles following denervation – more receptors for neurotransmitters are expressed and are therefore easier to stimulate. Phases 3 and 4 are characterized by hyperreflexia, or abnormally strong reflexes usually produced with minimal stimulation.
When are deep tendon reflexes restored?
Monosynaptic reflexes, such as the deep tendon reflexes, are not restored until Phase 3. Restoration of reflexes is not rostral to caudal as previously (and commonly) believed, but instead proceeds from polysynaptic to monosynaptic.
What is the first synapses to form?
The first synapses to form are from shorter axons, usually from interneurons – this categorizes Phase 3. Phase 4 on the other hand, is soma -mediated, and will take longer for the soma to transport various growth factors, including proteins, to the end of the axon.
