69 year-old gentleman with bipolar disorder, secondary Parkinsonism and smoldering CLL presented after requiring a walker for new stiffness and gait slowing. He described ‘heavy’ right hip flexors and falls when taking turns. A few months later, he developed urinary retention, constipation, and peri-rectal numbness. On exam, patient had myeloradiculopathy and cauda equina syndrome. He had lower extremity spasticity, pathologic hyperreflexia, partial C4 sensory level, and slow spastic gait. He also had right L2-L4 sensory-motor radiculopathy with dysesthesia and iliopsoas weakness. Pre-existing secondary Parkinsonism tremors and cogwheel rigidity were mild.