What mechanism causes hypotension in neurogenic shock?

Hypotension in neurogenic shock primarily occurs due to systemic vasodilation. In this type of shock, which can occur after spinal cord injuries or significant damage to the autonomic nervous system, there is a disruption in sympathetic tone. Normally, the sympathetic nervous system maintains vascular resistance through vasoconstriction. However, when this tone is lost, peripheral blood vessels dilate extensively, leading to decreased systemic vascular resistance. As a result, the heart cannot maintain adequate blood pressure despite normal or even increased blood volume. This widespread vasodilation is the key factor in the development of hypotension seen in patients experiencing neurogenic shock.