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January 26, 2016: Alice in Wonderland Syndrome

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January 26, 2016

Alice in Wonderland Syndrome

Alice in Wonderland Syndrome is a rare migraine variant characterized by visual hallucinations with distortions of perception and impairments of sense of time that precede or occur with headache. Visual disturbances include micro/macropsia (images perceived as smaller or larger than they are), teleopsia (images appearing further away than they are), and metamorphosia (perception of movement in its absence). Symptoms are variable in duration and respond to migraine treatment. Most cases of AIWS have been associated with migraine, but cases have been reported secondary to frontal lobe epilepsy, encephalopathy due to infectious mononucleosis, topiramate use, and varicella infection. The presumed etiology of AIWS is migrainous cortical dysfunction in the non-dominant posterior parietal lobe.

  1. Lanska JR, Lanska DJ. Alice in Wonderland Syndrome: somesthetic vs visual perceptual disturbance. Neurology 2013; 80: 1262.
  2. Evans RW, Rolak LA. The Alice in Wonderland Syndrome. Headache 2004; 44: 624.
  3. Lui GT, Volpe NJ, Galetta SL. Visual hallucinations and illusion. In: Neuro-Ophthalmology: Diagnosis and Management, 2nd ed. Elsevier; 2010: 393-412.

Submitted by Jonathan D. Santoro, MD, Pediatric Neurology Resident, PGY III, Lucile Packard Children’s Hospital at Stanford, Palo Alto, California.

Disclosures: Dr. Santoro reports no disclosures.

For more clinical pearls and other articles of interest to neurology trainees, visit Neurology. Listen to this week's Neurology Podcast.

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