In “Early Neurologic Deterioration in Lacunar Stroke: Clinical and Imaging Predictors and Association With Long-term Outcome,” Vynckier et al. reported that of 365 prospectively identified patients with lacunar stroke; early neurologic deterioration (END; persisting increase in NIHSS score by ≥ 2 points within 24 hours of admission) was associated with lower admission NIHSS score, capsular warning syndrome, ventral pontine infarct, hypoperfusion, and lack of initiation of dual antiplatelet therapy. They also reported END was associated with 90-day mRS score 3–6. Cao and Xia commented that when considering the outcome for patients with END after lacunar stroke, it is important to evaluate the interventions performed in response to the deterioration, such as endovascular treatment or initiation of anticoagulation or a glycoprotein IIb/IIIa inhibitor. The readers were also surprised to see that although only 16.7% of patients developed END, yet 48% of patients had a follow-up MRI performed at 24 ± 12 hours after their admission MRI. Vynckier et al. clarified that follow-up MRI was performed in all patients with END in addition to patients treated with intravenous thrombolysis or with transient neurologic symptoms that did not meet criteria for END. The authors agree that additional research and recommendations on the management of patients with lacunar strokes who have END is needed but noted that there is no evidence for the use of the therapies mentioned by Cao and Xia in this patient population.