BACKGROUND Limited documentation exists about how frequently radiologically visible rebleeding occurs with abusive subdural hemorrhages (SDH). Likewise, little is known about rebleeding predispositions and associated symptoms. OBJECTIVE To describe the frequency of subdural rebleeding after abusive head trauma (AHT), its predispositions and clinical presentation. MATERIALS AND METHODS We evaluated children with SDHs from AHT who were reimaged within a year of their initial hospitalization, retrospectively reviewing clinical details and imaging. We used the available CT and MR images. We then performed simple descriptive and comparative statistics. RESULTS Fifty-four of 85 reimaged children (63.5%) with AHT-SDH rebled. No child had new trauma, radiologic evidence of new parenchymal injury or acute neurologic symptoms from rebleeding. From the initial presentation, macrocephaly was associated with subsequent rebleeding. Greater subdural depth, macrocephaly, ventriculomegaly and brain atrophy at follow-up were associated with rebleeding. No other radiologic findings at initial presentation or follow-up predicted rebleeding risk, although pre-existing brain atrophy at initial admission and initial chronic SDHs barely missed significance. Impact injuries, retinal hemorrhages and clinical indices of initial injury severity were not associated with rebleeding. All rebleeding occurred within chronic SDHs; no new bridging vein rupture was identified. The mean time until rebleeding was recognized was 12 weeks; no child had rebleeding after 49 weeks. CONCLUSION Subdural rebleeding is common and occurs in children who have brain atrophy, ventriculomegaly, macrocephaly and deep SDHs at rebleed. It usually occurs in the early months post-injury. All children with rebleeds were neurologically asymptomatic and lacked histories or clinical or radiologic findings of new trauma. Bleeds did not occur outside of chronic SDHs. We estimate the maximum predicted frequency of non-traumatic SDH rebleeding accompanied by acute neurological symptoms in children with a prior abusive SDH is 3.5%.

中文翻译：

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受虐儿童的硬脑膜下出血再出血：发生频率，关联和临床表现。

背景技术存在关于滥用性硬膜下出血（SDH）在放射学上可见的再出血发生频率的有限文献。同样，关于再出血倾向和相关症状知之甚少。目的描述滥用性颅脑损伤后硬膜下再出血的频率，易感性和临床表现。材料和方法我们评估了在初次住院一年之内重新成像的AHT SDHs儿童，回顾性回顾了临床细节和影像学。我们使用了可用的CT和MR图像。然后，我们执行了简单的描述性和比较性统计。结果85名AHT-SDH患儿再成像后有54名（63.5％）出现出血。没有孩子有新的创伤，再出血的影像学证据或再出血引起的急性神经系统症状。从最初的表现来看，大头畸形与随后的再出血有关。随访时较大的硬膜下深度，大头畸形，脑室肥大和脑萎缩与再出血有关。初次出现或随访时没有其他放射学发现可预测再出血的风险，尽管初次入院时存在先前的脑萎缩和初次慢性SDH几乎没有遗漏任何意义。冲击损伤，视网膜出血和初始损伤严重程度的临床指标与再出血无关。所有再出血都发生在慢性SDH内；未发现新的桥接静脉破裂。直到发现再出血的平均时间为12周；49周后没有儿童再出血。结论硬脑膜下再出血是常见的，发生在脑萎缩，脑室肥大，大头畸形和深SDHs在再出血。它通常发生在受伤后的头几个月。所有患有再出血的儿童均无神经学症状，且无新病史或临床或影像学发现。慢性SDHs之外未发生出血。我们估计在先前有虐待性SDH的儿童中，非创伤性SDH再出血并伴有急性神经系统症状的最大预测频率为3.5％。