At the completion of this project the investigators will have evaluated a peripheral blood test that determines the expression of a multi-omic biomarker profile to differentiate stroke from no-stroke in the emergency setting. Two hundred and fifty patients aged 18 years or older who present to the hospital stroke like symptoms will be recruited within 12 hours of symptom onset at the University of Cincinnati Medical Center (UCMC) and/or participating regional hospitals served by the UC Stroke Team. Data will be obtained from the medical records. Blood for research purposes will be obtained. Research evaluations for stroke severity, symptoms and outcome will be performed by trained personnel. All clinical evaluation and management will be per standard of care.