• The occurrence of aphasia as the only or dominant symptom of subdural hematoma (SDH) has not been emphasized in the literature. The possible confusion of traumatic aphasia with transient ischemic attacks or stroke has been the object of most recent investigations. Four patients with subacute SDH had aphasia as an initial symptom; the relevant pathophysiologic characteristics were noted in each. These patients had a rapid response to decompression with marked resolution of the aphasia irrespective of immediate or delayed drainage.