A 55-year-old woman with chronic back pain initially presented to an outside facility with new-onset left facial droop, progressive paresthesia, and weakness in her extremities. Neuro-axis MRI showed moderate to severe multilevel spinal and neuroforaminal stenosis. No urgent neurosurgical intervention was warranted and she was advised to follow up with her outpatient surgeon and pain specialist. She was discharged with a course of prednisone and acyclovir for a diagnosis of left-sided idiopathic Bell’s palsy.

As the spectrum of GQ1b antibody syndrome broadens, we report a unique case of GQ1b positivity with Asialo-GM1 antibodies, presenting as unilateral facial palsy and limb weakness initially misattributed to a chronic spinal condition. This case highlights the importance of clinicians recognizing the potential link between ganglioside antibodies and presentations that mimic Bell’s palsy and spinal stenosis. Maintaining a high level of suspicion for such formidable mimickers can help mitigate morbidity and mortality.