Isolated congenital bilateral occipital perforations

A seven-month-old male Asian baby presented with headache and a large right parietal scalp hematoma after falling from a bed onto a wooden floor. The infant was previously well, born via non-traumatic vaginal delivery following uneventful pregnancy. Normal developmental and growth milestones were met. On examination, Glasgow Coma Scale was 15 with no neurological deficits. In accordance with local guidelines, the infant was investigated via low-dose computed tomography (CT) scan of the head. This showed a right-sided linear non-depressed skull fracture with normal intracranial appearances, seen in a volume-rendered 3D-CT scan (Figure 1). This was managed conservatively via overnight admission to a pediatric unit for observation, and discharged home at 24 hours with post-head injury advice for his parents. Isolated bilateral symmetrical occipital perforations were noted as an incidental finding. The foramina could be palpated gently without discomfort, and were not visibly pulsatile. The volume rendered 3D-CT scan shows full thickness bilateral 6 mm circular foramina with smooth contours in the occipital bone (closed arrows), each 25 mm from the midline (Figure 1). At final follow-up, the infant was well, all scalp