Answer: B. Neurogenic shock
The X-ray shows fractured C3 vertebra and displacement of C3 on C4. Further investigation with CT and MRI spine showed fracture and displacement of the right pedicle of C3, extending to right foramen transversarium of C3. There was also swollen spinal cord with intramedullary hematoma.
Spinal shock and neurogenic shock after neck trauma are not synonymous terms. Spinal shock refers to the physiologic and anatomic transection of the spinal cord, followed by loss or depression of all or most spinal reflex activity below the level of the injury. All these were present in this patient. However, for the part of hypotension and bradycardia, the condition is specifically referred to as neurogenic shock. Neurogenic shock refers to the vasodilatation, hypotension, decreased peripheral vascular resistance, decreased preload and bradycardia. Because the sympathetic nervous system extends from T1 to L1, any spinal cord injury above L1 is at risk for some degree of neurogenic shock, and especially so if it is around the level of T6.
Reference
Vernon W. Lin,Diana D. Cardenas. Spinal cord medicine: principles and practice