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summary: Background: Dysphagia is relatively common in patients with acute stroke and can lead to aspiration pneumonia and malnutrition. We evaluate the usefulness of dysphagia test using high-resolution impedance manometry during acute stroke. Methods: Consecutive patients with acute stroke were enrolled, and all patients were stratified into three aspiration risk groups. High-resolution impedance-manometry (HRiM) was performed in patients with an intermediate aspiration risk. The diet plan was determined based on the results of evaluations and clinical outcome was determined by improved diet program and pulmonary complications. Results: A total of 293 patients with acute stroke were enrolled. Among 91 patients with intermediate-risk, 36 revealed an impaired swallowing pattern in HRiM. Fifty-five patients with a preserved swallowing pattern and 169 with low-risk were started with a general diet and tolerated it well. Thirty-six patients with an impaired swallowing pattern were recommended for swallowing rehabilitation and a stepwise dysphagia diet of which 97.2% successfully adapted to the general diet. High-risk group patients received nasogastric tube feeding immediately. During admission, no patients with low- and intermediate-risk developed aspiration pneumonia. However, aspiration pneumonia frequently occurred in high-risk group patients. Conclusions: Our assessment program was safe and effective for assessing swallowing function and for determining the appropriate diet plan. Keywords: acute stroke, diet, dysphagia, high-resolution impedance manometry