Ben Garcia was a 54-year-old executive with a large, thriving investment company. He was well regarded among his clients as the consummate professional. He and his wife of 32 years had two children, both of whom were college graduates. Life was great until Mr. Garcia found, to his embarrassment, that he was occasionally impotent. His wife teased him gently about getting old. However, his impotence rapidly progressed from occasional to frequent to every time. Additionally, Mr. Garcia was experiencing urinary problems. He felt enormous urgency to urinate, but had difficulty producing a urinary stream. His embarrassment (because of the nature of his symptoms), combined with his busy schedule, kept him from seeking medical attention. It wasnt until he arose from bed one morning and fainted that he made an appointment with his physician. By the time he saw his physician, he had been feeling dizzy every morning for a month and had an array of symptoms that convinced him that something was terribly wrong. In addition to impotence, urinary difficulties, and dizziness when he stood up, he had double vision, indigestion, diarrhea, and heat intolerance. Mr. Garcia was referred to a neurologist who, based on the global nature of his symptoms and the results of a specific ocular test, diagnosed him as having ShyDrager syndrome, a rare, progressive disease of the central autonomic nervous system. ShyDrager syndrome is associated with degeneration of preganglionic neurons of the intermediolateral cell column of the spinal cord, autonomic ganglia in the periphery, and autonomic centers in the hypothalamus. As a result, both the sympathetic and parasympathetic divisions of the autonomic nervous system are profoundly impaired. As part of his treatment, Mr. Garcia was instructed to elevate his head during sleep and to wear support stockings to prevent blood from pooling in his veins. He also took an aldosterone analogue to increase his blood volume. Each of these measures was an attempt to ameliorate the dizziness and fainting that he experienced when he stood up. Mr. Garcia and his family understood that the treatments were palliative and that there was no cure for his degenerative disease. He died at home at 58 years of age, 4 years after the onset of his symptoms.