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Orthostatic hypotension is prevalent in the elderly, so much so that norms of blood pressure and pulse changes have been dif cult to establish Caird and coworkers reported that among individuals who were more than 65 years of age and living at home, 24 percent had a fall of systolic blood pressure on standing of 20 mmHg; 9 percent had a fall of 30 mmHg; and 5 percent, a fall of 40 mmHg An increased frequency of thermoregulatory impairment has been documented as well The elderly are also more liable to develop hypothermia and, when exposed to high ambient temperature, to hyperthermia Loss of sweating of the lower parts of the body and increased sweating of the head and arms probably re ect a senile neuropathy or neuronopathy The number of sensory ganglion cells decreases with age (Castro) Impotence and incontinence also increase with age, but these, of course, may be due to a number of processes besides autonomic failure It is of interest that the idiopathic type of small ber neuropathy that occurs predominantly in elderly women ( burning hands and feet syndrome) has no associated autonomic features (see Chap 46)

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Interruption of postganglionic sympathetic bers at any point along the internal carotid arteries or a lesion of the superior cervical ganglion results in miosis, drooping of the eyelid, and abolition of sweating over one side of the face; this constellation is the Horner, or more properly, Bernard-Horner syndrome (see also page 242) The same syndrome in less obvious form may be caused by interruption of the preganglionic bers at any point between their origin in the intermediolateral cell column of the C8-T2 spinal segments and the superior cervical ganglion or by interruption of the descending, uncrossed hypothalamospinal pathway in the tegmentum of the brainstem or cervical cord The common causes are neoplastic or in ammatory involvement of the cervical lymph nodes or proximal part of the brachial plexus, surgical and other types of trauma to cervical structures (eg, jugular venous catheters), carotid artery dissection, syringomyelic or traumatic lesions of the rst and second thoracic spinal segments, and infarcts or other lesions of the lateral part of the medulla (Wallenberg syndrome) There is also an idiopathic variety that is in some cases hereditary If a Horner syndrome develops early in life, the iris on the affected side fails to become pigmented and remains blue or mottled gray-brown (heterochromia iridis) A lesion of the stellate ganglion, eg, compression by a tumor arising from the superior sulcus of the lung, produces the interesting combination of a Horner syndrome and paralysis of sympathetic re exes in the limb (the hand and arm are dry and warm) With preganglionic lesions, facial ushing may develop on the side of the sympathetic disorder; this is brought on in some instances by exercise (harlequin effect) Keane has provided data as to the relative frequency of the lesions causing oculosympathetic (Horner) paralysis In 100 suc-

If you click on the page and the default Page_Load method has been removed from the C# code, a new one will appear Visual Studio 2008 is pretty smart and knows that if you have one page-loading event, another would just conflict with it In a single page-loading event function or subroutine, you can enter as many statements as you want, so having more than a single event handler for a single event does not make any sense even for multiple statements Some web controls like the Label do not generate event code when double-clicked in the Design mode The Label web control can be a useful information source, and with the right design you may well want labels with events and event handlers Fortunately, you can add certain events to virtually any web control if you want You just don t do it by double-clicking the object in the Design mode, as you will see in the next two sections

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Autonomic Neuropathy in Infants and Children (Riley-Day Syndrome) and Other Inherited Dysautonomias

In the Design or Split mode, if you select a web control, you can see the available events in the Properties window When you open the Properties window, click the Lightning Bolt icon All of the events for the selected web control appear The following steps provide a simple example: