Early discrimination of patients with ischemic stroke from stroke mimics (SMs) such as epileptic seizures or migraine attacks remains a diagnostic challenge. A differential diagnosis has important therapeutic implications, but since current routine diagnostic tools have limited capacity for differentiating ischemic stroke from SMs, there is a great need for novel diagnostic markers. Steffen Tiedt, PhD, Institute for Stroke and Dementia Research (ISD), Munich, Germany, discusses a study that investigated the utility of early metabolic changes for differentiating ischemic stroke from SMs. Untargeted metabolite profiling on serum samples was performed on patients with ischemic stroke, SMs, and neurologically normal controls. A set of four metabolites (asymmetrical and symmetrical dimethylarginine, pregnenolone sulfate, and adenosine) with known biological effects relevant to stroke pathophysiology showed high accuracy in differentiating patients with ischemic from patients with SMs. Studies are now focusing on developing quantification assays that can provide results quickly so appropriate treatment can be implemented. This interview took place during the Federation of European Neuroscience Societies (FENS) 2022 Forum in Paris, France.