A 60-year-old woman suffered from recurrent episodes of fever, hypertension, facial flushing, vomiting, stridor, slowly progressive symptoms of hypohidrosis, and orthostatic hypotension. The episodes were synchronous with elevated catecholamine concentration in plasma and urine. This is an example of paroxysmal autonomic hyperreflexia in a setting of pure progressive autonomic failure.

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Figure 1 Hyperbolic relationship of DLCOSS (BP-47)/VE (axis of abscissa) and COF (axis of ordinate). The two asymptotes are x=-k and y= k=1-VD/VT.

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