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An 80-year-old man presented to the neurology outpatient with a 1-year history of worsening mobility. His medical history included an ischaemic stroke in 2001 with residual left leg weakness, hypertension and osteoarthritis. At his initial visit, he arrived in a wheelchair, although he could still walk short distances at home using a stick. He had increasing slowness during daily activities, with difficulty reaching the toilet at night and had fallen several times. He had no symptoms of Rapid eye Movement sleep behaviour disorder, nor cognitive or behavioural symptoms, visual hallucinations, and orthostatic hypotension symptoms, nor previous use of a dopamine receptor blocker or a dopamine-depleting agent. He had been experiencing bladder emptying issues and was incidentally found to have an overdistended urinary bladder extending above the level of the umbilicus with mild bilateral hydronephrosis on CT colonogram ( figure 1).