Fig. 1.

Autonomic function testing in the husband.

Legend: Autonomic reflex screen and thermoregulatory sweat testing in the husband is shown. Cardiovagal impairment is shown (top left) with reduced heart rate (green) to deep breathing (blue), adrenergic failure on Valsalva maneuver (middle left) with absent late phase II and phase IV with prolonged blood pressure recovery time and orthostatic hypotension on head-up tilt (bottom left) with absent heart rate response. Thermoregulatory sweat test (middle) demonstrates widespread anhidrosis (yellow) that is predominantly in a central pattern based on quantitative sudomotor axon reflex testing (right panel) showing robust sweat responses at the forearm, proximal leg and foot sites and mild decrease at the distal leg site.