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Alice in Wonderland Syndrome : The disease and the story of Alice's Adventures

Dr Sampurna Roy MD 

 

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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.

On July4, 1862, Mr Dodgson and the three little girls, Lorina, Alice and Edith, went by boat on the Isis, which is part of Thames, from Oxford to Godstow and he spun a tale about a long and strange dream that the fictional child named Alice had on a warm summer day.  

On their return home Alice Liddell, then 10 years old, asked him to write out for her the full story of Alice's adventures. She received it later as Christmas present written in his beautiful handwritting and illustrated with his own drawings.

                      

 “I wonder if I've been changed in the night. Let me think. Was I the same when I got up this morning? I almost think I can remember feeling a little different. But if I'm not the same, the next question is 'Who in the world am I?' Ah, that's the great puzzle!”  - Lewis Carrol, Alice in Wonderland

“My dear, here we must run as fast as we can, just to stay in place. And if you wish to go anywhere you must run twice as fast as that.”  - Lewis Carrol, Alice in Wonderland

“How puzzling all these changes are! I'm never sure what I'm going to be, from one minute to another.” - Lewis Carrol, Alice in Wonderland

 

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.

Visit posts on infectious diseases: Infectious Mononucleosis ; Varicella ; Coxsackievirus Infection ; Lyme Disease

   

“I can't go back to yesterday because I was a different person then.” - Lewis Carrol, Alice in Wonderland

“If I had a world of my own, everything would be nonsense.”- Lewis Carrol, Alice in Wonderland

The book tells what happened to Alice after she followed a talking white rabbit into a rabbit hole and down into the depths of the earth where she met all sorts of interesting creatures.  

She experienced several dramatic changes in her own body size and shape (Example: shrinking to 10 inches high, growing unnaturally large and tall).

The medical symptoms of distorted body images match the literary description so precisely that illustrations from the original book depict them very accurately.S

ome scholars have speculated that Reverend Charles Lutwidge Dodgson may have experienced this syndrome himself.

       

“But I don’t want to go among mad people," Alice remarked.
"Oh, you can’t help that," said the Cat: "we’re all mad here. I’m mad. You’re mad."
"How do you know I’m mad?" said Alice.
"You must be," said the Cat, "or you wouldn’t have come here.” - Lewis Carrol, Alice in Wonderland

“Alice: Would you tell me, please, which way I ought to go from here?
The Cheshire Cat: That depends a good deal on where you want to get to.
Alice: I don't much care where.
The Cheshire Cat: Then it doesn't much matter which way you go.
Alice: ...So long as I get somewhere.
The Cheshire Cat: Oh, you're sure to do that, if only you walk long enough.”  - Lewis Carrol, Alice in Wonderland
 

 

“Take some more tea," the March Hare said to Alice, very earnestly.
"I've had nothing yet," Alice replied in an offended tone, "so I can't take more."
"You mean you can't take less," said the Hatter: "it's very easy to take more than nothing."
"Nobody asked your opinion," said Alice.”       
-Lewis Carrol, Alice in Wonderland
 

“The Mad Hatter: "Would you like some wine?"
Alice: "Yes..."
The Mad Hatter: "We haven't any and you're too young.” -Lewis Carrol, Alice in Wonderland

 

"Mad Hatter" of Alice's Adventures in Wonderland earned his name because he exhibited psychotic behavior from mercury poisoning. The first description of mercurialism in hatters was published by J. Addision Freeman, M.D., in Transactions of the Medical Society of New Jersey in 1860, just 5 years before Lewis Carrol's famous tale.

 

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.

In about one third of patients, the symptoms continue and one quarter of patients without a history of migraine may subsequently develop migraine.           

 

Further reading:

All story illustrations of Alice's Adventures in Wonderland from personal scrapbook photo collection.

Alice in Wonderland syndrome caused by the 2009 pandemic H1N1 influenza A virus.

Alice in Wonderland syndrome as a presenting symptom of EBV infection.

Alice in Wonderland syndrome, a manifestation of acute Epstein-Barr virus infection.

Alice in Wonderland syndrome caused by coxsackievirus B1.

[Characteristics and evolution of patients with Alice in Wonderland syndrome].

The Alice in Wonderland syndrome in juvenile migraine.

"Alice in Wonderland" syndrome as a presenting symptom of infectious mononucleosis in children: a description of three affected young people.

The syndrome of Alice in Wonderland.

Alice in wonderland" syndrome: presenting and follow-up characteristics.

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Dr  Sampurna Roy  MD

Consultant Histopathologist (Kolkata - India)

 

 


 

 

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