Orthostatic Intolerance and Chiari I Malformation

Lindsay S Petracek; Peter C Rowe

doi:10.1016/j.nec.2022.09.002

Orthostatic Intolerance and Chiari I Malformation

Neurosurg Clin N Am. 2023 Jan;34(1):43-54. doi: 10.1016/j.nec.2022.09.002.

Authors

Lindsay S Petracek¹, Peter C Rowe²

Affiliations

¹ Department of Pediatrics, Division of Adolescent and Young Adult Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Department of Pediatrics, Division of Adolescent and Young Adult Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: prowe@jhmi.edu.

PMID: 36424063
DOI: 10.1016/j.nec.2022.09.002

Abstract

Individuals with Chiari malformation can present with symptoms of fatigue, lightheadedness, and syncope-the cardinal features of orthostatic intolerance. Similar orthostatic symptoms can complicate the clinical course following Chiari decompression. The presence of orthostatic intolerance in patients with Chiari malformation is not surprising given the location of the major circulatory control centers and their pathways in the brainstem. This article reviews the normal physiologic response to upright posture and the common forms of orthostatic intolerance encountered in clinical practice. The authors describe the relationship between orthostatic intolerance and Chiari malformation and provide suggestions regarding the evaluation and management of these disorders.

Keywords: Cervical spinal stenosis; Chiari malformation; Craniocervical instability; Joint hypermobility; Neurally mediated hypotension; Orthostatic intolerance; Postural tachycardia syndrome; Syncope.

Publication types

Review

MeSH terms

Arnold-Chiari Malformation* / complications
Arnold-Chiari Malformation* / diagnosis
Arnold-Chiari Malformation* / surgery
Humans
Hypotension, Orthostatic* / complications
Orthostatic Intolerance* / complications
Orthostatic Intolerance* / diagnosis
Orthostatic Intolerance* / surgery