Atypical Symptoms in Migraine-Related Alice in Wonderland Syndrome: Expansion of the Phenotype and Reflection on the Pathomechanism

Abstract

We report an 8-year-old girl who experienced daily episodes of visual and somesthetic distortion and was diagnosed with Alice in wonderland syndrome (AIWS). Ophthalmologic assessment revealed best-corrected visual acuity of 0.2 in both eyes, and bilateral constricted tubular or spiral visual fields. Augmented amplitude of visually evoked potentials was revealed, and treatment with lomerizine and valproate showed favorable effect on the visual/somesthetic distortion as well as the visual field and acuity. Psychogenic visual problems can co-exist with the typical sensory distortion in AIWS, similarly to the case of psychogenic pseudo-seizures in subjects with epilepsy. Otherwise, an ambiguous borderline between psychological and physical pathomechanisms in migraine may also be characteristic of the migraine-related AIWS.

Down the Rabbit Hole: A literature review based on causes and consequences of the Alice in Wonderland Syndrome

“…The symptoms of Alice in Wonderland Syndrome have been attributed to functional and structural aberrations of the perceptual system 16 . The pathophysiology explanation considers that there would be an involvement of the occipital, temporal, and parietal lobes 17 . Occipito-temporal lobes are considered responsible for visual disorders such as phosphenes scotoma, teichopsia, while alterations of the parietal lobe cause the lack of spatial location and appearance of visual perceptions, such as dysmetropsias.…”

The Secrets of Alice in Wonderland Syndrome

“…The lengths of any seizure episode differ in each person, but time duration of 10 minutes up to 1 hour was decribed in literature [17][18][19][20][21]10]. Alice in Wonderland syndrome like seizures seem to be reproducible and be inducible by body part positioning and in mediation setting [22,23].…”

Visual Perception in Migraine: A Narrative Review

“…Lilliputian or Brobdingnagian vision (micropsia or macropsia): Objects or people perceived as too small or too large [55] Metamorphopsia: Objects or people are distorted, "monstrous faces in others" (MV), half of the observed face shifting upwards or downwards, or changes in lines or angles of the features of objects or faces [1,56] Misperceptions of body parts: segments of the body seen gigantically, transparent, perception of the body being split in two, vision of the hair growing quickly "to cover all the floor" (MV) [55,56] Teleopsia: Seeing objects as much farther. It may refer to walls, "giving the impression of a much larger ambient, or just one object in particular" (MV) [1] Pelopsia: Seeing objects as much nearer [1] Allesthesia: Objects are viewed inverted or at the opposite homonymous field [55] Polyopia: perception of objects or faces in many copies [56] Mononuclear diplopia [57] Tunnel vision [22,30] Prosopagnosia [37,38,52,53] Increased or decreased misperception in the rate of movement: "book pages passing too quickly", "lights in a tunnel succeeding in astonishing speed" (MV) [56] Apparent movement of stationary objects [56] Waviness of linear contours [56] Objects with sharper contours, with exaggerated perspective or without a third dimension, looking diagrammatic [43] Corona phenomena: perception of colored or shining border around objects [1,56] Oscillopsia [1] Fragmented visual perception resembling "cracked glass" Kaleidoscope-like, mosaic vision [43] Impression of seeing through water heat waves, like "looking at a distance close to the asphalt pavement in a very hot day" (MV) [1] "Like a negative of film" [22,30] Complex hallucinations [22,30] Anopia-transient cortical blindness [30] MV: personal observations.…”