Background: Dysphagia following acute stroke can be a serious threat to one's health because of the risk of aspiration pneumonia, malnutrition, dehydration, weight loss, and airway obstruction. There is an evidence that early enteral feeding via percutaneous endoscopic gastrostomy (PEG) is both beneficial and safe. Objectives: To predict risk factors ofprolonged dysphagia following acute stroke and proper management of similar cases. Subjects and Methods: This study was a prospective cohort study conducted on 113 patients with acute stroke admitted within 24 hours. Clinical findings and imaging results were prospectively collected, and subsequent progress was recorded. Subjects were divided into 3 groups for analysis: no dysphagia; transient dysphagia (≥14 days); or prolonged dysphagia (>14 days). Particular attention was paid to bulbar function. Stroke severity was assessed using the National Institutes of Health Stroke Scale on admission and on discharge. The water swallow test was performed to all patients who were able to attend sufficiently to follow the instructions. Modified Barium Swallow or Video-fluoroscopy test was done for some patients to detect the oropharyngeal dysphagia.  Results: Significant associations for prolonged dysphagia were seen with large stroke, increased stroke severity, dysphasia and lesions of the frontal and insular cortex and presence of old vascular insult on brain imaging. Conclusion: These results indicated that it is potentially possible to identify those patients who have prolonged significant dysphagia following acute stroke at an early time point. This would allow the judicious use of early PEG to avoid aspiration pneumonia and for better nutrition.