Alice in Wonderland syndrome: “Who in the world am I?”

Abstract

Alice in Wonderland syndrome (AIWS) is a paroxysmal, perceptual, visual and somesthetic disorder that can be found in patients with migraine, epilepsy, cerebrovascular disease or infections. The condition is relatively rare and unique in its hallucinatory characteristics. Objective: To discuss the potential pathways involved in AIWS. Interest in this subject arose from a patient seen at our service, in which dysmetropsia of body image was reported by the patient, when she saw it in her son. Methods: We reviewed and discussed the medical literature on reported patients with AIWS, possible anatomical pathways involved and functional imaging studies. Results: A complex neural network including the right temporoparietal junction, secondary somatosensory cortex, premotor cortex, right posterior insula, and primary and extrastriate visual cortical regions seem to be involved in AIWS to varying degrees. Conclusions: AIWS is a very complex condition that typically has been described as isolated cases or series of cases.

Adding pieces to the Alice in wonderland syndrome puzzle: a comment to the paper by Brooks and colleagues

“…Dear Editor, We have read with great interest the paper by Brooks and colleagues about their patient experiencing Alice in Wonderland syndrome (AIWS), following a brain hemorrhage. Interestingly, the patient had a past medical history of migraine with aura (MA); and AIWS, although secondary to a hemorrhage, was followed by a pulsatile headache 1 . We appreciate the effort of the authors to combine results from different case reports to draw a clearer pattern of AIWS.…”

“…To date, the pathophysiology of AIWS remains elusive and far to be fully understood. By reading the paper by Brooks et al 1 , two questions come to mind. First, is AIWS due to alterations in a specific brain region or rather a more complex fronto-temporal-parietal network?…”