Immediately following SCI, spinal shock occurs in the portion of the spinal cord that is injured

and results in a complete loss of all motor, sensory, reflex, and autonomic function below the
level of the injury. This loss is manifested in loss of bowel and bladder tone and peripheral
vascular tone, which result in bladder distention, paralytic ileus, flaccid paralysis, and
hypotension.
After a period that varies from hours to months, but which usually lasts for 1 to 6 weeks, the
spinal neurons gradually regain their excitability and the period of spinal shock ends. The earliest
indication is the return of the perianal reflexes. The bulbocavernous reflex has returned if a slight
muscle contraction follows squeezing of the glans penis or pulling the indwelling catheter. The
anal flex has returned if there a puckering of the anal sphincter following a digital examination of
the rectum, insertion of a rectal thermometer, or a scratching of the skin around the anal area. The
flaccid paralysis during spinal shock is replaced by spastic paralysis during recovery.
The degree of neuron excitability that returns can be greater than before the injury. Depending
on the degree of spinal shock and the completeness of the injury, either:
Transmission of impulses will resume, along with motor, sensory, reflex, and autonomic
activity below the level of the injury, or,
The isolated cord segment will develop its own reflex activity: minimal reflex activity, flexor
spasm activity, alternating flexor and extensor spasm activities, and predominent extensor
spasm activity
Spinal shock recovery can, therefore, be accompanied by complications such as autonomic
hyperreflexia, and sexual, bladder, and autonomic dysfunctions.
Neurogenic shock is the temporary loss or disruption of autonomic nervous system innervation
below the level of injury, which can cause orthostatic hypotension, bradycardia, lower than
normal body temperature, and loss of the ability to perspire. Orthostatic hypotension is the rapid
drop in blood pressure when an erect position is assumed, due to inadequate blood supply to the
brain, which can result in brain damage or death. The systolic pressure can drop as low as 40 mm
Hg, the diastolic pressure can decrease to 0 mm Hg, and pooling of blood in the abdomen and
lower extremities can occur.