A 62-year-old male who worked at lead battery company, with no significant history, presented to neurology clinic for bilateral leg weakness and heaviness and difficulty initiating walk causing falls for past 6 months. Wife reported memory issues, but patient was independent with activities of daily living. Initial exam showed bradykinesia, masked facies, diffuse hyperreflexia, reduced arm swing, and en bloc turning with no cogwheel rigidity. MoCA score was 21/30 with points lost on visuospatial, abstraction, and delayed recall. He met criteria for Parkinson’s disease and was started on Sinemet trial. Labs showed RPR, TSH, Vitamin B12, MMA, vitamin B1, folate, copper, and lead within normal limits. MRI Brain showed severe stenosis of inferior cerebral aqueduct and dilation of proximal ventricular system with transependymal flow. MRI Cervical spine done for diffuse hyperreflexia showed mild central spinal stenosis at level of C4-C5. He continued to have falls and underwent ventriculoperitoneal shunt placement. Subsequent CT head showed substantially decreased hydrocephalus. Patient’s gait improved significantly with persistent mildly reduced arm swing and en bloc turning and his MoCA improved to 27/30. Sinemet was gradually tapered and eventually discontinued.