Alice in Wonderland Syndrome-Like Seizure and Refractory Supraventricular Tachycardia

Abstract

Alice in Wonderland syndrome (AIWS) is a rarely curious visual perceptual disorder which has been associated with diverse neurologic and psychiatric problems. It may be a manifestation in migraine, epileptic seizures, encephalitis, other brain lesions, medication-related side effects, schizophrenia, and depressive disorders. Principal character of AIWS is the disproportion between the external world and the self-image in which micropsia (objects appear smaller), macropsia (objects appear larger), and teleopsia (objects appear further away) are frequently reported. The cases of temporal lobe epilepsy may present with complex visual auras of visual distortions (e.g., micropsia and macropsia) like AIWS. We report an unusual case of an elderly man who presented with AIWS, focal impaired awareness seizures, ictal tachyarrhythmia, multiple episodes of transient visual disturbances of macropsia and transient loss of consciousness. During those symptoms, telemetry showed self-limited supraventricular tachycardia several times which could not be regulated with heart rate-controlled medication. The electroencephalography was later tested and showed rhythmic theta activity over the right cerebral hemisphere. He was treated with levetiracetam, and all his symptoms and tachyarrhythmias were gradually resolved thereafter. Refractory response to treatment would remind the physicians to reassess for the correct diagnosis.

The Secrets of Alice in Wonderland Syndrome

“…Genetic analysis of familial cases should reveal any sources of mutation or genetic disturbance in these patients [2,3]. Further intensive research is necessary to clear the origin of this mysterious syndrome [24][25][26][27][28][29][30][31][32][33][34].…”

Lilliputian Hallucination-An Exceptional Psychiatric Symptom

“…He deprived of over-the-counter medication misuse, food and drug allergy, and a family history of unexpected cardiac death or epilepsy. 10 Report No. 3-A case of 78-year-oldemeritus male -with comorbid condition of diabetes and hypothyroidism -was referred to the psychiatric department in Kolkata Medical collegefrom ophthalmology of the same hospital for VH of 1-year time period.…”