E-Pearls of the Week: "Well, I never heard it before, but it sounds uncommon nonsense"

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July 22, 2013

"Well, I never heard it before, but it sounds uncommon nonsense" [1]

The Alice in Wonderland syndrome is a rare phenomenon characterized by errors in visual perception. [2] Objects or body parts may appear distorted (metamorphopsia) or smaller (micropsia) or larger (macropsia) than normal.  This can be accompanied by visual hallucinations or an altered awareness of the passage of time.  A wide range of etiologies have been reported: Migraine; epilepsy; posterior reversible encephalopathy syndrome; cerebral space occupying lesions; viral encephalitis; and psychosis. [3]  Anatomically, the posterior parietal and occipital lobes have been implicated.  It has been proposed that Charles Lutwidge Dodgson's migraines prompted his use of similar imagery in Alice's Adventures in Wonderland. [1]


  1. Carroll L. Alice's Adventures in Wonderland. London: Macmillan and Co.; 1865
  2. Evans RW, Rolak LA. The Alice in Wonderland syndrome. Headache 2004; 44: 624-625.
  3. Gorman G, Hutchinson M, Tubridy N. Clinical Reasoning: A case of Wegener granulomatosis complicated by seizures and headaches: curiouser and curiouser. Neurology 2009; 72: e11-14.

Submitted by:  Sridevi Shetty MBBS MPH and John Carmody MRCPI FRACP Wollongong Hospital, Wollongong, Australia

Disclosure:  Drs Shetty and Carmody report no disclosures.

For more clinical pearls and other articles of interest to neurology trainees, visit Neurology®. Visit the E-Pearl of the Week Archive. Listen to this week'sNeurology Podcast


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