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نوروژنیک
Damage to the sympathetic outflow to the heart and vasculature after SCI contributes to systemic hypotension and bradycardia due to unopposed vagal tone, commonly referred to as neurogenic shock.136 Injuries above T7 have an 85% risk of serious cardiovascular instability.137 To avoid secondary injury after SCI, the MAP should be kept above 85 to 90 mm Hg during the first 7 days after injury using fluid and vasopressor therapy.138,139 Fluid ther- apy should be monitored by cardiac output monitoring devices and hypotonic solutions like dextrose 5% in water, Ringer´s lactate, and 0.45% sodium chloride should be avoided, as they worsen cord edema.
Neurogenic Cardiac and Pulmonary Disturbances.
This phenomenon of neurogenic stunned myocardium can cause severe limitation of cardiac contractility, which is reversible and associated with a good recovery profile.
High serum levels are associated with increased hemorrhage, hemodynamic fluctuations, and worse outcomes.172 Release of troponin can represent cardiac ischemia in patients with atherosclerotic heart dis- ease or a "myocardial leak" from neurogenic injury.172
Pulmonary injury is a frequent complication after SAH, with nearly 17% of patients developing severe pulmonary dysfunction, including ARDS, which is associated with poor neurologic outcome.173 In addition to acquired respiratory infections, common in ventilated ICU patients, neurogenic pulmonary edema caused by increased permeability of the pulmonary vasculature can occur in isolation or in combi- nation with neurogenic cardiac problems.174
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