A 51-year-old African American man with known LHON presented with worsening lower extremity weakness and numbness. Over the preceding two weeks, he had gone from being able to ambulate independently around his home to being wheelchair-bound. He developed a sensory level below the T4 dermatome to light touch, pinprick, and vibration. Magnetic Resonance Imaging (MRI) of his cervical and thoracic spine showed a T2 hyperintense lesion extending from C2 to T12. Notably, he had a similar presentation about two years earlier and at that time was found to have a longitudinally extensive myelopathy that, after extensive evaluation, was thought to be due to Lebers Plus. Genetic testing showed a 3635 G to A mutation. MRI at this presentation demonstrated a lesion lateral to his prior C1-T10 lesion. Evaluation for infectious or autoimmune causes for his myelopathy were unrevealing and he was diagnosed with recurrent myelopathy secondary to Leber’s Plus.