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The Chiari type I malformation (CM1) is characterized by herniation of cerebe llar tonsils to at least 3- 5 mm below the plane of foramen magnum and can pres ent with a wide variety of clinical symptoms, frequently including occipital hea daches, secondary to bulbar and/or medullary distress. Rarely, syncopal episodes have also been described and attributed to either compression of the midbrain a scending reticular system, or vascular compromise (vertebrobasilar artery compre ssion, hypotension). We report the first case of a CM1 patient with frequently r ecurring syncope due to postural orthostatic tachycardia syndrome (POTS), a form of orthostatic intolerance, whose symptoms resolved completely after surgical i ntervention. It is important to stress that it is not clear whether the describe d association of POTS and CM1 in our patient is a fortuitous finding in an isola ted case or a reflection of a more systematic association between the two pathol ogies.
The Chiari type I malformation (CM1) is characterized by herniation of cerebe llar tonsils to at least 3-5 mm below the plane of foramen magnum and can pres ent with a wide variety of clinical symptoms, frequently including occipital hea daches, secondary to bulbar and / or medullary distress. Rarely, syncopal episodes have also been described and attributed to either compression of the midbrain a scending reticular system, or vascular compromise (vertebrobasilar artery compresion, hypotension). We report the first case of a CM1 patient with frequently r ecurring syncope due to postural orthostatic tachycardia syndrome (POTS), a form of orthostatic intolerance, whose symptoms resolve completely after surgical i ntervention. It is important to stress that it is not clear whether the describe d association of POTS and CM1 in our patient is a fortuitous finding in an isola ted case or a reflection of a more systematic association between the two pathol ogies.