Alice in Wonderland syndrome

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Alice in Wonderland syndrome (AIWS, named after the novel written by Lewis Carroll), also known as Todd's syndrome^[1], is a disorienting neurological condition which affects human perception. Sufferers may experience micropsia, macropsia, and/or size distortion of other sensory modalities. A temporary condition, it is often associated with migraines, brain tumors, and the use of psychoactive drugs.^{[citation needed]} It can also present as the initial sign of the Epstein-Barr Virus (see infectious mononucleosis). Anecdotal reports suggests that the symptoms of AIWS are fairly common in childhood^{[citation needed]}, with many people growing out of them in their teens. It appears that AIWS is also a common experience at sleep onset.

Signs and symptoms

Eye components are entirely normal. The AIW syndrome is a result of change in perception as opposed to the eyes themselves malfunctioning. The hallmark sign of AIWS is a migraine, and may in part be caused by the symptom itself. Using psychoactive drugs (notably dextromethorphan, LSD, psilocybin mushrooms or other hallucinogenic drugs) may also produce micropsia. AIWS affects the sufferer's sense of visual, sensation, touch, hearing as well as one's own body image.

The most prominent and often most disturbing symptom is that of altered body image: the sufferer will find that they are confused as to the size and shape of parts of (or all of) their body.

The eyes themselves are normal, but the sufferer 'sees' objects with the wrong size or shape and/or finds that perspective is incorrect. This can mean that people, cars, buildings, etc. look smaller or larger than they should be, or that distances look incorrect; for example a corridor may appear to be very long, or the ground may appear too close.

In addition, some people may experience more intense and overt hallucinations, seeing things that are not there and misinterpreting events and situations in conjunction with a high fever.

Diagnosis

Because AIWS is a disturbance of perception rather than a specific physiological change to the body's systems, the diagnosis can be presumed when other, physical causes have been ruled out and if the patient presents with migraines, altered senses and complains of onset during darkness (although it can occur in light).

Delirium tremens, a serious complication of withdrawal from alcohol, can also cause lilliputian hallucinations - visual hallucinations of small animals or people. Delirium tremens requires urgent medical treatment.^[2]

Treatment

Treatment is the same as that for other migraine prophylaxis: anticonvulsants, antidepressants, beta blockers, and calcium channel blockers, along with strict adherence to the migraine diet.

Epidemiology

No studies are available that display any correlation between age, gender or race. AIWS is thought to be relatively common among migraine sufferers and young children.

References

• PMID 12207198
• Kew, J., Wright, A., & Halligan, P.W. (1998). Somesthetic aura: The experience of "Alice in Wonderland", The Lancet, 351,p1934