Stiffness of the tongue when speaking may be a symptom of the extrapyramidal system, most commonly seen in Parkinson’s disease, Parkinson’s syndrome, and hepatomegaly. In the case of basal ganglia lesions, such as basal ganglia cerebral infarction and cerebral hemorrhage, patients may also have a stiff tongue when speaking. Patients may also have facial muscle stiffness, which manifests as a masked face, stiffness in the extremities, or due to certain medications. For example, if the patient is older than 75 years old, the application of metoclopramide or phenothiazines can also cause extrapyramidal symptoms, which are manifested as described above. If the patient has cerebrovascular disease, such as left-sided cerebral infarction or cerebral hemorrhage, speech dysfunction may occur, which also manifests itself as a hardened tongue and poor speech, usually with an acute onset. Cerebral hemorrhage mostly starts during activity, and cerebral infarction usually starts in quiet state, and cranial CT examination can clarify the diagnosis.