Alice in Wonderland Syndrome: A Clinical and Pathophysiological Review

Abstract

Alice in Wonderland Syndrome (AIWS) is a perceptual disorder, principally involving visual and somesthetic integration, firstly reported by Todd, on the literary suggestion of the strange experiences described by Lewis Carroll in Alice in Wonderland books. Symptoms may comprise among others aschematia and dysmetropsia. This syndrome has many different etiologies; however EBV infection is the most common cause in children, while migraine affects more commonly adults. Many data support a strict relationship between migraine and AIWS, which could be considered in many patients as an aura or a migraine equivalent, particularly in children. Nevertheless, AIWS seems to have anatomical correlates. According to neuroimaging, temporoparietal-occipital carrefour (TPO-C) is a key region for developing many of AIWS symptoms. The final part of this review aims to find the relationship between AIWS symptoms, presenting a pathophysiological model. In brief, AIWS symptoms depend on an alteration of TPO-C where visual-spatial and somatosensory information are integrated. Alterations in these brain regions may cause the cooccurrence of dysmetropsia and disorders of body schema. In our opinion, the association of other symptoms reported in literature could vary depending on different etiologies and the lack of clear diagnostic criteria.

Is it Useful to Do a Taxonomy of Complex Visual Symptoms in Migraine? A Comment on Coining the Pablo Picasso Syndrome

“…Similar symptoms, as precisely pointed out by Suri and Ali, also occur in migraine‐associated Alice in Wonderland Syndrome (AIWS) 2 and, also in that case, seem to depend on migraine pathophysiology. In a recent report, 3 we described a 47‐year‐old woman, who suffered from migraine with aura since her adolescence.…”

Aripiprazole-Triggered Alice in Wonderland Syndrome Episodes Studied with 99mTc-HMPAO Brain SPECT

“…Interestingly, among the causes of AIWS, there are both migraine and some drugs [1][2], but this is the first case of AIWS attributable to an antipsychotic.…”

New-onset Alice in Wonderland syndrome following brucellosis

“…The name refers to Lewis Carrol's children's book Alice's Adventures in Wonderland, in which the title character experiences alterations of sensation in which she felt that her body had grown too tall or too small, or parts of her body were changing shape, size, or relationship to the rest of her body. The syndrome was first described in 1952 by Lippman, and given its name by Todd in 1955 (7).…”