When Neurological Symptoms Hide a Life-Threatening Hemorrhage: A Case Report of Diagnostic Challenges and Management of Hemorrhagic Shock From an Aberrant Radial Artery.

BACKGROUND Anatomical variations of the radial artery are present in 10-20% of individuals. Such variations can impact management and clinical outcomes in vascular interventions, trauma, or surgeries. These abnormalities can pose diagnostic and therapeutic challenges, especially in cases of vascular trauma requiring prompt intervention. CASE REPORT We present the case of a 66-year-old woman with a history of bilateral lung transplantation, atrial fibrillation on anticoagulation, and prior breast cancer, who developed hemorrhagic shock following a fall. Initially presenting with neurological symptoms, her condition rapidly worsened, leading to unresponsiveness and coma. Initial imaging excluded intracranial pathology, but repeated imaging then revealed a large right chest wall hematoma with active bleeding from an aberrant radial artery originating from the axillary artery. The patient was managed with aggressive fluid resuscitation, blood transfusion, anticoagulation reversal, and ultimately interventional radiology. Radio-embolization allowed successful embolization of the bleeding vessel with preservation of hand perfusion. Further questioning revealed that the bleeding was caused by nursing management and by her complex medical history of steroid intake, lymph node dissection, and radiotherapy. CONCLUSIONS To the best of our knowledge this is the first description of hemorrhagic shock due to an aberrant radial artery originating from the axillary artery. The case underscores the diagnostic complexity of hemorrhagic shock in patients with abnormal vascular anatomy and significant comorbidities. It highlights the critical role of interventional radiology in managing such cases and the importance of multidisciplinary collaboration to ensure timely diagnosis, effective treatment, and prevention of ischemic complications. We discuss the current literature and management of complex upper-limb vascular trauma.