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Orthostatic intolerance and syncope associated with Chiari type I malformation
  1. O Prilipko1,
  2. A R Dehdashti2,
  3. S Zaim3,
  4. M Seeck1
  1. 1Presurgical Epilepsy Evaluation Unit, Program of Functional Neurology and Neurosurgery of the Universities of Lausanne and Geneva, Switzerland
  2. 2Neurosurgery Clinics, University Hospital of Geneva, Switzerland
  3. 3UMDNJ-New Jersey Medical School, Newark, New Jersey, USA
  1. Correspondence to:
 Dr M Seeck
 Presurgical Epilepsy Evaluation Unit, Department of Neurology, Hôpital Cantonal Universitaire de Genève, 24 rue Micheli-du-Crest, CH-1211 Genève 14, Switzerland;


The Chiari type I malformation (CM1) is characterized by herniation of cerebellar tonsils to at least 3–5 mm below the plane of foramen magnum and can present with a wide variety of clinical symptoms, frequently including occipital headaches, secondary to bulbar and/or medullary distress. Rarely, syncopal episodes have also been described and attributed to either compression of the midbrain ascending reticular system, or vascular compromise (vertebrobasilar artery compression, hypotension). We report the first case of a CM1 patient with frequently recurring syncope due to postural orthostatic tachycardia syndrome (POTS), a form of orthostatic intolerance, whose symptoms resolved completely after surgical intervention. It is important to stress that it is not clear whether the described association of POTS and CM1 in our patient is a fortuitous finding in an isolated case or a reflection of a more systematic association between the two pathologies.

  • BP, blood pressure
  • CM1, Chiari type I malformation
  • HR, heart rate
  • NTS, nucleus tractus solitarii
  • OI, orthostatic intolerance
  • POTS, postural orthostatic tachycardia syndrome

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  • Competing interests: none declared