Orthostatic Intolerance and Chiari I Malformation

Lindsay S. Petracek, Peter C. Rowe

Research output: Contribution to journalReview articlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)43-54
Number of pages12
JournalNeurosurgery clinics of North America
Issue number1
StatePublished - Jan 2023


  • Cervical spinal stenosis
  • Chiari malformation
  • Craniocervical instability
  • Joint hypermobility
  • Neurally mediated hypotension
  • Orthostatic intolerance
  • Postural tachycardia syndrome
  • Syncope

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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