The evaluation of difficulty speaking begins with a medical history and physical examination.

Physical findings in someone with difficulty speaking due to stroke may include:

• Sudden numbness in one arm or leg:
• Arm numbness (unilateral)
• Leg numbness (unilateral)
• Arm and leg numbness (unilateral)
• Sudden weakness in one arm or leg:
• Arm weakness (unilateral)
• Leg weakness (unilateral)
• Arm and leg weakness (unilateral)
• Facial weakness (unilateral):
• Facial drooping
• Difficulty swallowing
• Difficulty walking
• Difficulty with balance
• Loss of coordination
• Memory loss
• Confusion

Physical findings in someone with difficulty speaking due to angioedema may include:

• Facial swelling
• Lip swelling
• Mouth or tongue swelling

Testing may be required to evaluate the sudden onset of difficulty speaking, with no clear underlying cause.

Tests that may be used to evaluate stroke or TIA include:

• CT scanning of the brain
• MRI scan of the brain
• SPECT scanning of the brain:
• A newer method that may provide earlier detection of stroke in some cases
• PET scanning of the brain:
• Detects levels of brain activity
• Blood clotting studies
• Electrocardiogram
• Serum electrolytes
• Serum glucose
• Pulse oximetry

A stroke or TIA may be caused by narrowing of the blood vessels in the neck, called the carotid arteries.

Tests that may be used to evaluate the carotid arteries include:

• Carotid angiogram:
• A special x-ray procedure that can detect blood vessel narrowing in the carotid arteries, which often cause strokes.
• Carotid duplex ultrasound:
• Can detect narrowing and reduced blood flow in the carotid arteries that supply the brain

Tests that may be used to screen for conditions that increase the risk of a stroke include:

• C-reactive protein
• Coagulation profile
• Bleeding time
• Homocysteine level
• Lipid profile:
• Serum LDL
• Serum HDL
• Serum VLDL
• Total cholesterol level
• Lp-PLA2:
• Often elevated in people who are at high risk for stroke