This article discusses a case of atypical imaging findings in a patient with anti-GQ1b brainstem encephalitis. The patient, a 63-year-old male with a history of tongue cancer, presented with symptoms including headache, diplopia, and gait unsteadiness. Brain MRI revealed extensive brainstem lesions with ring enhancement, as well as the presence of microhemorrhages. The patient was treated with intravenous immunoglobulins and experienced near-complete clinical recovery. The article highlights the rarity of these imaging findings and emphasizes the importance of anti-GQ1b screening in cases of brainstem encephalitis.