⚡ Neurogenic Shock vs Autonomic Dysreflexia
Same patient, same spinal cord injury, opposite autonomic crises — one is a complete failure of sympathetic tone, the other is an unregulated explosion of it.
The Key Insight — Same Injury, Opposite Crises
Both conditions occur in patients with high spinal cord injuries (typically cervical or upper thoracic, at or above T6). The cord injury is the same. But the timing is different, the mechanism is opposite, and getting the two confused in an emergency could kill the patient — because the treatments are diametrically opposed.
The Single Most Important Distinguishing Fact
Blood pressure tells you which one you are dealing with:
📉 Neurogenic Shock = HYPOTENSION — sympathetic tone is lost, vessels collapse, BP falls
📈 Autonomic Dysreflexia = HYPERTENSION — sympathetic tone explodes uncontrolled, vessels constrict below the lesion, BP rockets
Both cause bradycardia — from opposite causes (one from unopposed vagal tone on a hypotensive patient; the other from the baroreflex slamming the brakes on a hypertensive patient). This shared bradycardia is the trap. The BP is what tells them apart.