Evaluation of difficulty swallowing starts with a medical history and physical examination.

Physical findings in someone with difficulty swallowing 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 walking
• Difficulty with balance
• Loss of coordination
• Memory loss
• Confusion

In most cases, testing is necessary to evaluate difficulty swallowing.

Tests that may be used to evaluate difficulty swallowing include:

• Serum amylase
• Serum lipase
• Complete blood count
• Barium swallow
• Chest x-ray
• Esophageal manometry:
• Measuring the pressure inside the esophagus
• Esophagoscopy
• Upper GI endoscopy

Because strokes and TIAs can cause difficulty swallowing, tests may be required to evaluate stroke as a cause of difficulty swallowing.

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