Abnormal arterial anatomy and an unexpected intracranial haemorrhage

A baby boy was born at term by spontaneous vaginal delivery to non-consanguineous parents following an unremarkable pregnancy. He was admitted to his local neonatal intensive care unit shortly after birth following several episodes of eye-rolling, colour change and apnoea. He had bilateral parieto-occipital cephalohaematomata, scattered petechiae and intermittent hypotonia. He was otherwise neurologically normal. A septic screen was completed and antibiotics and aciclovir were given. Cranial ultrasound, cerebral function monitoring and electroencephalography were normal. An echocardiogram demonstrated normal function and intracardiac anatomy but was suspicious for a dysplastic aortic arch and anomalous left pulmonary artery-aorta connection thus he was transferred to the regional paediatric cardiology centre where cardiac CT (figure 1) was undertaken. CT brain (figure 2) was performed simultaneously to delineate the cerebral vascular anatomy but demonstrated an intracranial lesion that accounted for the baby's presentation.