Alice in Wonderland Syndrome :
The disease and the story of
In 1955, English psychiatrist John Todd
(1914-1987) described Alice in Wonderland syndrome.
The term applied to altered bizarre perceptions of size and shapes of a patient's body and illusions of changes in the forms, dimensions, and motions of objects that a patient with this syndrome encounters.
John Todd named Alice in Wonderland syndrome for the perceptual disorder of altered body image experienced by Alice, the key character in the novel Alice's Adventures in Wonderland (1865), written by Lewis Carroll (the pseudonym of Reverend Charles Lutwidge Dodgson [1832-1898]).
The author suggests that Dodgson suffered from migraine headaches and used these experiences to weave an amusing tale for Alice Liddell.
The author also discusses the neurology of mercury poisoning affecting the behavior of Mad Hatter character.
According to the author the drowsy and sleepy Dormouse suffered from excessive daytime sleepiness due to obstructive sleep apnea.
The transient episodes of visual hallucinations and perceptual distortions, during which objects or body parts are perceived as altered in various ways (metamorphopsia), including enlargement (macropsia) or reduction (micropsia) in the perceived size of a form.
These metamorphopsias arise during complex partial seizures, migraine headaches, infections, and intoxications.
Such episodes are of short duration (generally less than an hour), variable frequency (up to several times per day), and unpredictable onset.
Cases of "Alice in Wonderland" syndrome have been described associated with infectious mononucleosis.
In each clinical case, the classical infectious mononucleosis symptoms and diagnosis followed the onset of visual aberration.
Nuclear medicine techniques are able to demonstrate changes in cerebral perfusion and may be used to detect abnormal cerebral areas in patients with Alice in Wonderland syndrome.
This uncommon, but often easy to recognise syndrome, to which children seem particularly susceptible, have been reported in patients with Epstein-Barr Virus infection.
Few cases have been reported following varicella and coxsackievirus B1 infection.
A case of Alice in Wonderland syndrome was reported in a 7-year-old boy associated with Lyme Disease.
He presented with metamorphopsia and auditory hallucinations in the absence of previous tick bites or other signs of Lyme disease.
The boy never developed clinical seizures, and electroencephalograms during these spells indicated no epileptic activity.
There was no history of migraine. Cranial magnetic resonance imaging produced normal results.
Lyme serology tested positive in both serum and cerebrospinal fluid.
This condition typically affect young children, and the most common visual complaints are micropsia (objects appear smaller than their actual size ) and teleopsia (visual disturbance in which objects appear to be farther away than they actually are).
The most common associated condition is infection (mainly Epstein-Barr virus infection) , but half of these individuals have no obvious trigger.
Magnetic resonance imaging and electroencephalography are not helpful.
Alice in Wonderland Syndrome is a benign process and there is spontaneous resolution without recurrence in the majority of cases.
All story illustrations of Alice's Adventures in Wonderland from personal scrapbook photo collection.
"Alice in Wonderland" syndrome as a presenting symptom of infectious mononucleosis in children: a description of three affected young people.
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