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Eating and swallowing are activities that are normally performed without conscious thought. This complex behaviour – involving 5 pairs of cranial nerves and 26 pairs of muscles – can be interrupted by a stroke, leading to dysphagia. Dysphagia is associated with aspiration (where material passes into the respiratory tract) and aspiration carries a risk of pneumonia seven times greater than that of the normal population. Around 15% 20% of all stroke patients will develop respiratory tract infections during the acute phase of their stroke. Pneumonia is one of the leading causes of mortality in the acute stroke patient. Respiratory infections add to hospital length of stay and are associated with significant increases in the cost of patient care, as well as being associated with poorer outcomes for the patient. This chapter will outline the association of dysphagia and other risk factors in the development of respiratory infections in acute ischemic stroke patients.