Genetic testing evidenced a novel, unique pathogenic variant on the NF-1 gene<i>. </i>The patient underwent combined bypass surgery first and then was placed on aspirin and a blood pressure control regimen. Our case illustrates the need for clinicians to include moyamoya disease in the list of differential diagnoses when encountering a young patient, without major risk factors, presenting with ischemic stroke. The gene discussed is NF1; the disease is ischemic stroke.