A Novel NODAL variant in a young embolic stroke patient with visceral heterotaxy

Abstract

Abstract Background: Ischemic stroke in young adults can be caused by a variety of etiologies including the monogenic disorders. Visceral heterotaxy is a condition caused by abnormal left-right determinations during embryonic development. We aimed to determine the cause of a young ischemic stroke patient with visceral heterotaxy. Case presentation: We performed neurological, radiological, and genetic evaluations in a 17-year-old male patient presenting ischemic stroke and visceral heterotaxy to determine the underlying cause of this rare disease combination. Brain MRI showed evidence of embolic stroke, abdominal CT showed visceral heterotaxy, and echocardiogram showed cardiac anomaly with right-to-left-shunt (RLS). Whole genome sequencing (WGS) revealed a heterozygous missense variant (NM_018055.5: c.1016T > C, p.(Met339Val)) in the NODAL gene, which is essential to the determination of the left-right body axis. Conclusions: Our study highlights the importance of evaluating genetic causes in young ischemic stroke of unknown cause and the need for stroke risk management in visceral heterotaxy patients with RLS. To the best of our knowledge, we report the first genetically-confirmed case of visceral heterotaxy with young embolic stroke reported to date.