Positional aphasia as a manifestation of syndrome of the trephined: illustrative case

BACKGROUND: The authors report a case of a 66-year-old male who presented acutely with a subdural hematoma who was managed operatively with craniotomy. His course was complicated by a postoperative epidural hematoma, which, on the basis of intraoperative findings at the second surgery, was managed with evacuation of the hematoma and removal of the bone flap. OBSERVATIONS: The patient’s subsequent recovery was remarkable for a reproducible positional aphasia in the early postoperative period with an ultimate diagnosis of syndrome of the trephined. The patient’s cerebral edema permitted early autologous cranioplasty, which resulted in resolution of the patient’s symptoms. LESSONS: The authors believe this case to be the first described of isolated positional aphasia as a manifestation of syndrome of the trephined. Recognition and treatment of the syndrome resulted in a positive patient outcome.