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Alice in Wonderland Syndrome

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Ginny Nguyen

on 21 April 2014

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Transcript of Alice in Wonderland Syndrome

Case Study 3
Betty. "Alice in Wonderland Syndrome." BBC News. BBC, n.d. Web. 11 Apr. 2014.

Brumm K, Walenski M, Haist F, Robbins S, Granet D, Love T. 2010. Functional magnetic resonance imaging of a child with Alice in Wonderland syndrome during an episode of micropsia. Journal of American Association for Pediatric Ophthalmology and Strabismus. 14(4): 317-322

Dimple G, Bernard P. 2013. Complex hallucinations and panic attacks in a 13-year-old with migraines. Innovations in Clinical Neuroscience. 10(1):30-32

George, D., & Bernard, P. (2013). Complex hallucinations and panic attacks in a 13-year-old with migraines: The alice in wonderland syndrome.
Innovations in Clinical Neuroscience
, 10(1), 30-32.

Gorriah, V., F.W Favazza, and M. Fort-Ramirez. "Steroid-Induced Psychosis Presenting as Alice in Wonderland Syndrome." Jefferson Journal of Psychiatry (n.d.): n. pag. Web.

Hamed S. 2010. A migraine variant with abdominal colic and Alice in wonderland syndrome: a case report and review. BioMed Central. 10:2

Jenke, A. C. W., Borusiak , P., & Wagner, A. (2010). Long-term outcome of alice-in-wonderland-syndrome: results from a case series of 12 patients. Neuopediatrics, 2010(41), 1374. doi: 10.1055/s-0030-1265619

"Alice in Wonderland Syndrome Treatment." Alice in Wonderland Syndrome Treatment. N.p., n.d. Web. 11 Apr. 2014.

Weidenfeld , A., & Bourusiak , P. (2011). Alice-in-wonderland syndrome--a case-based update and long-term outcome in nine children. Children's Nervous System , 27(6), 893-896. doi: 10.1007/s00381-011-1400-6

Alice in Wonderland Syndrome
Case Study 1
Steroid-Induced Psychosis Presenting as Alice
in Wonderland Syndrome
Patient X: a 40 year old Male

Past Medical History
- Renal tubular acidosis, bronchial asthma and hypertension
Mental Examination
- Had good reasoning, judgement, coherent,
- Tremors of fingers, anxious, and tremulous voice
- Auditory and visual hallucinations
Hospital/Clinic course
-Macropsia, zoopsia
-"Couldn't tell illusions from reality"
- Symptoms began about 6 months after he was started on high doses of steroids.

Case interesting because patient’s psychotic symptoms were misdiagnosed as schizophrenia

Case Study 2
Patient Y: 7 year old girl

Patient's Symptoms
Distorted images - Her mother’s hands appeared being green and abnormally small when compared to the rest of her body.
Attacks that would last a few minutes

Examinations noted
Normal brain scans but the presence of the EBV
All of her color vision at the eye level was completely normal.
No agnosia (the inability to recognize sounds, objects, or smells even though there is no problem with memory or the sensory organs themselves)
No dysphasia (inability to speak)
By: Humzah Nasir
Ginny Nguyen
Sruveera Sathi

- Disease first identified in 1955 by John Todd
- Named after Lewis Carroll’s
The Adventures of Alice in Wonderland
- Typically manifests in childhood; benign, self-terminating
- Found in association with variety of disorders: migraines, epilepsy, EBV, cerebral lesions, intoxication with hallucinogenic drugs
- Found in patients with family history of migraines and epilepsy

Distorted body image perceptions
Body parts (hands, feet, head) seem to be larger/smaller; surrounding objects and images are much larger/smaller and closer/farther than they should be
-Micropsia or Macropsia

Skewed sense of time, sound, touch
Time seems to move abnormally quickly or slowly; sound is distorted; ground feels spongy and patients feel like they are in quicksand
-Distortions can recur several times a day and may take some time to abate. the sufferer can become alarmed, frightened, even panic-stricken.
-Symptoms not harmful and likely to disappear with time.
- Migraine prophylaxis, i.e., anti depressants, anti convulsants, and calcium channel blockers.
- Strict migraine diet (steer clear of chocolates, meat, refined sugar, refined flour and most denatured foods).
- AIWS symptoms that have been triggered by migraines diminish with changes in diet and lifestyle; that ward off episodes of migraine.
Epstein-Barr Virus
-Most common virus found in humans
-Can cause IM which can lead to AIWS

Temporal Lobe Epilepsy
-Recurrent seizures in temporal lobe
-Altered sensations (ex. smell)
-Causes disturbances in memory
AIWS is a neurological disorder which can cause distortions in the perceptions of: image, body, time, touch and sound

Distortions caused by abnormal electrical activity causing problems with the amount of blood that flows to the visual and texture processing centers of the brain
Functional MRI of a child with Alice in Wonderland Syndrome during an episode of micropsia

Patient: 12-year-old boy with viral-onset AIWS
fMRI was conducted in response to
1) Passive viewing task (reversing checkerboard)
2) Active viewing task (line-length decisions in the context of the Ponzo illusion).
In passive, hypoactivation limited to the left hemisphere of the calcarine gyrus, with no differences between participants in other occipital ROIs
For the active viewing task, the child with AIWS had more extensive hypoactivation, in both the calcarine and lingual gyrus ROIs bilaterally
Results consistent with studies of viral-onset AIWS with abnormal EEG patterns and hypoperfusion in occipital regions
In AVT, which requires visual perception, attention, and size comparison between two visual stimuli, found hyperactivation of right superior parietal cortex as well as bilateral inferior parietal cortical regions AIWS child reactive to the control participant
Consistent pattern of occipital hypoactivation and parietal hyperactivation
Complex Hallucinations and Panic Attacks in a
13-year-old with Migranes

Patient: 13 year old girl

Family history of migraine, epilepsy, depression, and substance abuse

: Hearing voices in head, time moving abnormally slowly, loss of strength in hands

: Pizotifen reduced frequency and intensity of migraines; also reduced perceptual disturbance and anxiety. Addressed anxiety through psychoeducation, relaxation training, cognitive behavior therapy
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