0:00

Okay, so last is the special cases.

0:02

So these are things like that, that they're kind

0:05

of slam dunk if you see them,

0:06

but you have to know that they exist.

0:08

All right? So hemorrhage, right?

0:10

So normal birth, they're going through the birth canal.

0:12

It's okay to have a little bit

0:13

of subdural slash intradural blood products, right?

0:15

I mean, who wouldn't after squeezing your head around?

0:18

But it should be like relatively little

0:20

and it should resorb, you know, um,

0:22

maybe in the first like few weeks or month after birth.

0:25

Okay? Delivery assist. So vacuum forceps, right?

0:28

These things can be pretty traumatic,

0:30

even sometimes a c-section if they're like yank in the head.

0:33

And so you have subarachnoid, subdural.

0:35

You can also have something called sub peel hemorrhage.

0:37

So there's this p uh, be beneath the p mater again,

0:40

that the blood brainin bears immature

0:42

and neonate, so they don't have their gl lns.

0:44

And so there's this potential space.

0:45

And so you see this kind of triangular collections

0:48

and sub aira,

0:49

which just layer right along multiple soul side gyre

0:52

and not push on the parenchyma.

0:54

But these actually create mass effect

0:56

because they're trapped, right?

0:57

Kind of like between one or two GY and socy.

1:00

And so they create ischemia.

1:01

Classically, they're in the

1:02

temporal regions, but they can be anywhere.

1:04

So that's sape hemorrhage.

1:07

Most newborns get vitamin K injection in their thigh within

1:10

six hours of birth to prevent this very thing.

1:12

So this family declined the injection.

1:15

And so, you know, the kid couldn't produce clotting factors.

1:17

So they presented with a lot of like subarachnoid,

1:19

subdural interventricular hemorrhage, um,

1:22

and then a abuse of head trauma.

1:23

So here we have a stella multi-directional fracture.

1:26

We have, you know, actual cortical vein thrombosis

1:28

and kinking, and then they can have these

1:30

asymmetric ischemia.

1:31

Some people think it's like from the shaking

1:33

and maybe like the strangulation of one carotid

1:36

and so forth.