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Updated: Mar 25, 2026

Tilt Testing with Combined Lower Body Negative Pressure: a "Gold Standard" for Measuring Orthostatic Tolerance
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Orthostatic Cerebral Hypoperfusion Syndrome.

Peter Novak1

  • 1Department of Neurology, Brigham and Women's Faulkner Hospital, Harvard Medical School , Boston, MA , USA.

Frontiers in Aging Neuroscience
|February 25, 2016
PubMed
Summary

Orthostatic cerebral hypoperfusion syndrome (OCHOs) is a newly identified condition causing dizziness due to reduced blood flow to the brain without low blood pressure. This syndrome may be a common cause of unexplained orthostatic dizziness.

Keywords:
OCHOsOHPOTSQASAThypoperfusionhypotensionorthostatic

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Area of Science:

  • Neurology
  • Cardiovascular Physiology
  • Autonomic Nervous System

Background:

  • Orthostatic dizziness is common, but its underlying causes are often unclear.
  • Existing diagnostic criteria for orthostatic intolerance do not fully explain dizziness in all patients.
  • The pathophysiology of orthostatic dizziness without hypotension requires further elucidation.

Purpose of the Study:

  • To describe a novel syndrome termed orthostatic cerebral hypoperfusion syndrome (OCHOs).
  • To define the diagnostic criteria for OCHOs, focusing on cerebral blood flow velocity (CBFv) during orthostatic stress.
  • To investigate the prevalence and characteristics of OCHOs in patients with unexplained orthostatic dizziness.

Main Methods:

  • Retrospective analysis of patients undergoing autonomic testing for unexplained orthostatic dizziness.
  • Standardized tilt testing with continuous monitoring of heart rate, end-tidal CO2, blood pressure, and middle cerebral artery CBFv via transcranial Doppler.
  • Screening for OCHOs based on abnormal orthostatic CBFv drop without hypotension or other identifiable causes.

Main Results:

  • 102 patients met the OCHOs criteria from 1279 screened individuals.
  • OCHOs patients exhibited a significantly greater decrease in mean CBFv during tilt (24.1%) compared to controls (4.2%) (p < 0.0001).
  • No significant differences in baseline hemodynamics, blood pressure response, heart rate, or end-tidal CO2 were observed between OCHOs and control groups during tilt.

Conclusions:

  • Orthostatic cerebral hypoperfusion syndrome (OCHOs) is characterized by a significant drop in cerebral blood flow velocity upon standing, independent of orthostatic hypotension.
  • Proposed mechanisms for OCHOs include active cerebral vasoconstriction or increased peripheral venous compliance.
  • OCHOs represents a potentially common and underdiagnosed cause of orthostatic dizziness.