**1. Introduction**

Imagine that you are in the trauma bay receiving a patient with a suspected high spinal cord injury due to a motor vehicle crash. Emergency medical responders sign out to you that the blood pressure has been fine on the way in, 110/60 mmHg with a heart rate in the 60s. As you complete your primary survey and get the patient on to your monitors you find the pressure has plummeted to 80/50 but rather than tachycardia the patient's heart rate is only 45. The rhythm is sinus bradycardia, the hemoglobin on your initial lab is 14.4 g/dl and there is no clear source of blood loss.

All too often neurogenic shock is an under-recognized but deadly cause of hypotension, bradycardia, and other complications related to spinal cord injury. In this chapter, we examine the definition, diagnosis, and treatment taking special care to differentiate it from spinal shock. We also briefly discuss autonomic dysreflexia and the role that neurogenic shock and autonomic dysreflexia can play in the rehabilitation setting.
