What are the appropriate steps to take when experiencing slurred speech?

Slurred Speech: Immediate Action Required

Call 911 immediately if you or someone else experiences slurred speech, as this is a cardinal sign of stroke and requires emergency evaluation within minutes to hours, not days. 1

Emergency Recognition and Response

Slurred speech is one of the three critical stroke warning signs identified by the American Heart Association's Cincinnati Prehospital Stroke Scale, and the presence of this single abnormality indicates a 72% probability of stroke. 1

You must activate emergency medical services (911) immediately rather than seeking primary care or waiting to see if symptoms resolve. 1 The American Heart Association emphasizes that educational efforts must couple knowledge of stroke symptoms with immediate action—calling 911. 1

Why Immediate Action Matters

• Time-critical treatment window: Stroke treatments are most effective within the first few hours of symptom onset, and delays in seeking care directly worsen outcomes including mortality, morbidity, and quality of life. 1
• High early stroke risk: Approximately 30% of patients who experience slurred speech as part of a transient ischemic attack (TIA) and delay seeking attention will have a recurrent, potentially devastating stroke before receiving medical care. 2
• Common dangerous delay: Studies show that approximately 30% of patients with stroke warning signs delay seeking medical attention for more than 24 hours, and about 70% do not correctly recognize their symptoms as stroke-related. 2

Critical Stroke Warning Signs to Recognize

The American Heart Association identifies these symptoms that should trigger immediate 911 activation: 1

• Sudden trouble speaking or understanding speech (slurred words, using wrong words, or inability to speak)
• Sudden confusion
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause
• Facial drooping (one side of face doesn't move as well)
• Arm weakness or drift (one arm drifts down when both held out)

Common Pitfalls That Delay Life-Saving Care

Do not wait to see if symptoms resolve on their own. 2 Even if slurred speech improves or disappears within minutes to hours (a TIA), this represents a medical emergency requiring urgent evaluation within 24 hours, as the risk of a major stroke is highest in the days immediately following. 3, 2

Do not call your primary care physician first. 2 While 77% of patients initially contact their primary care physician, this delays critical stroke evaluation and treatment. Emergency medical services provide the fastest route to appropriate stroke center care. 1

Do not dismiss symptoms because they seem minor or brief. 2 Patients with shorter duration events, absence of motor symptoms, or TIA rather than stroke are significantly more likely to delay seeking care, yet these patients remain at high risk for devastating recurrent stroke. 2

Do not assume you're "too young" or that demographic factors matter. 2 Age, sex, social class, and educational level are unrelated to stroke risk when symptoms are present—anyone experiencing slurred speech needs immediate evaluation. 2

What Happens After Calling 911

• EMS dispatch prioritization: Emergency medical telecommunicators are trained to identify stroke symptoms and provide high-priority dispatch. 1
• Prehospital stroke assessment: Paramedics will use validated screening tools (Cincinnati Prehospital Stroke Scale or Los Angeles Prehospital Stroke Screen) with 86-97% sensitivity for identifying stroke after training. 1
• Direct transport to stroke center: EMS will transport you directly to an appropriate stroke-capable hospital, bypassing delays that occur when patients self-present to non-stroke centers. 1
• Prehospital notification: EMS notifies the receiving hospital to activate stroke resources before arrival, further reducing time to treatment. 1

Alternative Causes Requiring Different Urgent Evaluation

While stroke is the most critical concern with slurred speech, other serious conditions require prompt but different evaluation pathways:

If Slurred Speech Occurs With Voice Change (Hoarseness)

Seek laryngoscopy evaluation if slurred speech is actually hoarseness/voice change rather than articulation difficulty. 1 The American Academy of Otolaryngology recommends visualization of the larynx when:

• You are a smoker or heavy alcohol user (2-3 fold increased cancer risk) 1
• You have a neck mass or lymphadenopathy 1
• You have hemoptysis, difficulty swallowing, ear pain, or airway compromise 1
• Hoarseness persists beyond 3 months 1
• You recently had neck surgery, intubation, or cervical spine surgery 1

If Slurred Speech Occurs With Other Neurological Symptoms

Seek urgent neurological evaluation if slurred speech occurs with difficulty swallowing, tongue weakness, or progressive symptoms, as this may indicate amyotrophic lateral sclerosis, myasthenia gravis, or other serious neurological conditions. 1

Bottom Line Algorithm

1. Slurred speech + sudden onset + any stroke warning sign → Call 911 immediately 1
2. Slurred speech that resolved but occurred within last 7 days → Seek emergency or urgent TIA clinic evaluation within 24 hours 3, 2
3. Voice change/hoarseness (not articulation problem) + high-risk features → Seek laryngoscopy evaluation urgently 1
4. Progressive speech difficulty + swallowing problems + neurological signs → Seek urgent neurology evaluation 1

When in doubt, err on the side of calling 911. The consequences of delayed stroke treatment far outweigh the inconvenience of emergency evaluation for a non-stroke cause. 1, 2