Alice in Wonderland Syndrome

Caused by a disturbance of perception rather than an actual physiological change
Altered body image (Ex: big buildings look same size as person’s own body)
Distorted perception of size (micropsia, macropsia)
Distorted perception of the shape of objects
Loss of spatial perspective (sense of time and space)
Auditory or tactile hallucinations

AIWS generally affects a younger population and has several associated conditions. Migraine is the classic disease linked to AIWS, the distorted sensations can either begin before a migraine (aura or “warning”) or afterwards, and in younger patients can even occur without headache

Check out these first-hand accounts of people with this interesting phenomenon:
Size Matters: Living in a Lewis Carroll ‘Wonderland’ – ABC News

When the world looks like a real-life Wonderland

Experience: I have Alice In Wonderland syndrome 

A Not So Pleasant Fairy Tale: Investigating Alice in Wonderland Syndrome | Serendip Studio

Other causes of Alice in Wonderland Syndrome are:
psychoactive drugs
infectious mononucleosis
malignancy
temporal lobe epilepsy

Certain tests & imaging studies help rule out secondary causes:
urine toxicology screen
monospot test   
(for mononucleosis)
MRI brain
with and without contrast (to look for malignancy)
EEG   
(to detect seizures or seizure-like activity)

Sounds scary, right? Well, good news is it’s not as bad as it sounds. Most patients who experience AIWS as children will outgrow the condition as adults. Patients should be monitored for worsening of symptom severity and frequency. If all studies are negative and the patient continues to improve clinically, then further evaluation and/or treatment is not needed. Best management for future attacks is focused on migraine prophylaxis and lifestyle modifications (healthy diet, regular exercise, adequate sleep).

Posted By Sidra Ghafoor, Drexel University College of Medicine Class of 2013

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