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.
Shortly thereafter, she presented to our facility with worsening symptoms. Examination revealed diminished strength, hypoesthesia, and areflexia throughout. A left lower motor neuron cranial nerve palsy was noted, but the remainder of her cranial nerve exam was unremarkable. There was no ophthalmoplegia or ataxia. She denied any preceding viral prodrome. A lumbar puncture revealed albuminocytologic dissociation. Serologic testing was largely unremarkable, except for a serum ganglioside panel showing positive GQ1b and Asialo-GM1 antibodies. The patient was started on IVIg with remarkable improvement. Outpatient EMG/NCS and maintenance IVIg are planned.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.