Speech disturbance was evaluated in the acute stage of 34 patients with left putaminal hemorrhage. Twenty-two patients were surgically treated and 12 were medically treated. Word cognition, naming, and obedience to verbal command were evaluated according to the STLA severity grade, and speech disturbance in the acute stage was classified as 10 severe cases, 13 moderate cases and 9 mild cases. Severity of speech disturbance was correlated to severity of hemiparesis, volume of hematoma and extension of hematoma. The cases with hematomas extending to the corona radiata showed severe speech disturbance. At the time of re-evaluation about one month after the initial evaluation, 13 cases showed improvement of the disturbance to some extent, but 19 cases showed no improvement. The improvement was related to severity of initial speech disturbance, type of hematoma and volume of hematoma. The hematomas whose volumes were over 30ml were related to poor recovery. However, the cases with hematomas extending to the posterior part of the corona radiata showed poor improvement even though the volume was less than 30 ml. In conclusion, these clinical factors, especially the degree of hematoma extension shown on CT scan, are useful for diagnosis and evaluation of speech disturbance in putaminal hematoma.