Multisensory perceptual distortion including auditory distortions in Alice in Wonderland syndrome: a case report.

Alice in Wonderland syndrome (AIWS) is a rare perceptual disorder characterized mainly by perceptual distortions of visual objects and one's own body. While there are many case reports of visual and somatosensory distortions associated with AIWS, little is known about auditory distortion. Therefore, we present the case of a 22-year-old right-handed woman who described having auditory as well as visual and somatosensory distortion experiences and a family history of AIWS. The subject reported experiencing multisensory perceptual distortions, where she sees other people's faces as larger and hears their voices as louder at the same time. This particular case suggests that auditory distortion - which contributes to constructing the perception of the surrounding space and the body - may also be characterized as a perceptual symptom of AIWS.

A singular association of migraine with brainstem aura and Alice in Wonderland syndrome.

BACKGROUND: In this work, we describe an association of brainstem headache with aura (BHA) and Alice in Wonderland syndrome (AIWS) in a 17-year-old male, suffering from crises of vertigo, weakness, dysarthria, and diplopia, in half-hour duration, followed by diffuse or occipital headache, lasting several hours. METHODS: The frequency of the attacks was monthly, and once there was short loss of consciousness. The last episodes were accompanied by symptoms such as deformation of figures and objects, small or large in shape. RESULTS: Diagnostic examinations were performed, mainly neuroimaging tests such as brain MRI and brain angio-MRI, all resulting normal; and treatment with flunarizine was followed by improvement of both BHA and AIWS symptoms. CONCLUSIONS: There would be a correlation between BHA and AIWS, presumably represented by dysfunction of temporo-parieto-occipital carrefour.

Beyond differences between the body schema and the body image: insights from body hallucinations.

The distinction between the body schema and the body image has become the stock in trade of much recent work in cognitive neuroscience and philosophy. Yet little is known about the interactions between these two types of body representations. We need to account not only for their dissociations in rare cases, but also for their convergence most of the time. Indeed in our everyday life the body we perceive does not conflict with the body we act with. Are the body image and the body schema then somehow reshaping each other or are they relatively independent and do they only happen to be congruent? On the basis of the study of bodily hallucinations, we consider which model can best account for the body schema/body image interactions.

A case of recurrent depressive disorder presenting with Alice in Wonderland syndrome: psychopathology and pre- and post-treatment FDG-PET findings.

BACKGROUND: Alice in Wonderland syndrome (AIWS) is a rare neuropsychiatric syndrome that typically manifests in distortion of extrapersonal visual image, altered perception of one's body image, and a disturbed sense of the passage of distance and time. Several conditions have been reported to contribute to AIWS, although its biological basis is still unknown. Here, we present the first case demonstrating a clear concurrence of recurrent depressive disorder and AIWS. The clinical manifestations and pre- and post-treatment fluorodeoxyglucose positron-emission tomographic (FDG-PET) images provide insights into the psychopathological and biological basis of AIWS. CASE PRESENTATION: We describe a 63-year-old Japanese male who developed two distinct episodes of major depression concurrent with AIWS. In addition to typical AIWS perceptual symptoms, he complained of losing the ability to intuitively grasp the seriousness of news and the value of money, which implies disturbance of high-order cognition related to estimating magnitude and worth. Both depression and AIWS remitted after treatment in each episode. Pre-treatment FDG-PET images showed significant hypometabolism in the frontal cortex and hypermetabolism in the occipital and parietal cortex. Post-treatment images showed improvement of these abnormalities. CONCLUSIONS: The clinical co-occurrence of depressive episodes and presentation of AIWS can be interpreted to mean that they have certain functional disturbances in common. In view of incapacity, indifference, devitalization, altered perception of one's body image, and disturbed sense of time and space, the features of AIWS analogous to those of psychotic depression imply a common psychopathological basis. These high-order brain dysfunctions are possibly associated with the metabolic abnormalities in visual and parietotemporal association cortices that we observed on the pre- and post-treatment FDG-PET images in this case, while the hypometabolism in the frontal cortex is probably associated with depressive symptoms.

The study of time perception in migraineurs.

OBJECTIVE: The study aimed to explore the impairment of time perception in migraineurs. BACKGROUND: Headache is the most common pain syndrome in middle-aged adults, and migraine is highly prevalent and severely disabling. Although the mechanisms of and the therapies for migraines have long been explored, less is known about the functional impairments associated with them, especially the impairment in time perception, that is, the ability to estimate the passage of time. METHODS: In this study, we used a temporal reproduction task to assess the estimation of the duration of visual stimulus in 27 migraine patients. The stimulus was delivered at different intervals over the milliseconds and seconds range. RESULTS: In the setting of an interstimulus interval for 1 second and an interstimulus interval for 5 seconds in the 600-millisecond-duration reproduction task, the migraineurs showed impairment in time perception, and in that they significantly overestimated the duration, as compared with the healthy subjects. When compared with the healthy controls for the 3-second and 5-second duration reproduction task, migraineurs in the setting of an interstimulus interval for 1 second and an interstimulus interval for 5 seconds did not show impairment in time perception. CONCLUSIONS: This study indicates that not only is time perception impaired in migraineurs, but that this impairment is exhibited for durations in the milliseconds range, and not the seconds range.

Alice in wonderland syndrome in an elderly patient with focal onset epilepsy.

Alice in wonderland syndrome (AIWS) is a rare perceptual disorder characterized by subjective distortions of visual and somatosensory perception. Symptoms of AIWS are attributable to functional and structural changes of the visual and somatosensory perceptual system; however, few reports have investigated the pathophysiology of AIWS with regard to epilepsy, especially ictal electroencephalogram (EEG) changes. Herein, we describe the case of an 82-year-old woman with focal onset epilepsy presenting with AIWS, whose seizures were documented by video-EEG monitoring. Video-EEG revealed multiple focal impaired awareness seizures, and ictal EEG changes arose from the right occipital region with small periodic positive discharges with evolution towards the right centro-parietal regions. Our case highlights not only a relationship between epileptic seizures and AIWS but also provides pathological insight into AIWS.

The Alice-in-Wonderland Syndrome.

In 1955, English psychiatrist John Todd defined the Alice-in-Wonderland syndrome (AIWS) as self-experienced paroxysmal body-image illusions involving distortions of the size, mass, or shape of the patient's own body or its position in space, often accompanied by depersonalization and/or derealization. AIWS had been described by American Neurologist Caro Lippman in 1952, but Todd's report was the most influential. Todd named the syndrome for the perceptual disorder of altered body image experienced by the protagonist in Alice's Adventures in Wonderland (1865) by Lewis Carroll (Charles Lutwidge Dodgson). In Carroll's original story, Alice experienced several dramatic changes in body size and shape (e.g., shrinking to 10 inches high, growing unnaturally tall but not any wider, and growing unnaturally large). Todd reported 6 cases of AIWS, all of whom had episodic body-image distortions like those experienced by Lewis Carroll's Alice character; some also had visual perceptual disturbances, but none had visual perceptual disorders without body-image distortions. Therefore, AIWS may be accompanied by visual perceptual disorders (e.g., micropsia, macropsia, telopsia, pelopsia), but basing the diagnosis of AIWS on isolated visual perceptual disorders, as has subsequently been done by a number of authors, is inaccurate and misleading. Cases of isolated visual illusions without self-perceived distortions of body size, shape, or form, do not meet Todd's original criteria, nor are they commensurate with the experiences of the protagonist in Alice's Adventures in Wonderland. Furthermore, such cases differ by age and etiology from those that involve somesthetic perceptual disorders. Therefore, the use of the term AIWS for isolated visual illusions is problematic and should be discouraged. Although Todd's and Lippman's cases were adolescents or adults, AIWS is most commonly reported in children. Reported causes include infection (especially with Epstein Barr virus), migraine, epilepsy, depression, and toxic and febrile delirium.

Alice in Wonderland Syndrome: A Clinical and Pathophysiological Review.

Alice in Wonderland Syndrome (AIWS) is a perceptual disorder, principally involving visual and somesthetic integration, firstly reported by Todd, on the literary suggestion of the strange experiences described by Lewis Carroll in Alice in Wonderland books. Symptoms may comprise among others aschematia and dysmetropsia. This syndrome has many different etiologies; however EBV infection is the most common cause in children, while migraine affects more commonly adults. Many data support a strict relationship between migraine and AIWS, which could be considered in many patients as an aura or a migraine equivalent, particularly in children. Nevertheless, AIWS seems to have anatomical correlates. According to neuroimaging, temporoparietal-occipital carrefour (TPO-C) is a key region for developing many of AIWS symptoms. The final part of this review aims to find the relationship between AIWS symptoms, presenting a pathophysiological model. In brief, AIWS symptoms depend on an alteration of TPO-C where visual-spatial and somatosensory information are integrated. Alterations in these brain regions may cause the cooccurrence of dysmetropsia and disorders of body schema. In our opinion, the association of other symptoms reported in literature could vary depending on different etiologies and the lack of clear diagnostic criteria.

Alice in Wonderland Syndrome associated with a temporo-parietal cavernoma.

Alice in Wonderland Syndrome (AIWS) is characterized by a rare constellation of perceptual disturbances including distorted body image, metamorphopsia, and visual hallucinations. In this report, we relate a unique case of AIWS in a woman with a right temporo-parietal cavernoma. AIWS in this patient may be secondary to epileptiform activity associated with the cavernoma and improved with anti-epileptic treatment.

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

BACKGROUND: We investigated the distribution of symptoms and etiologies of patients with "Alice in Wonderland" syndrome (visual perception of change in one's body size) and "Alice in Wonderland"-like syndrome (extrapersonal illusions) at presentation and to determine their prognosis. DESIGN: Retrospective chart review and telephone interview. METHODS: Charts of children diagnosed with "Alice in Wonderland" syndrome by a pediatric neuro-ophthalmologist between July 1993 and July 2013 were reviewed. Patients seen before 2012, or their parents, were contacted for follow-up information. RESULTS: A total of 48 patients (average age 8.1 years) diagnosed with "Alice in Wonderland" syndrome or "Alice in Wonderland"-like syndrome were identified. Common visual symptoms were micropsia (69%), teleopsia (50%), macropsia (25%), metamorphopsia (15%), and pelopsia (10%). Magnetic resonance imaging and electroencephalography were unrevealing in 21 of 21 and 23 of 23 cases, respectively. The etiology was infection in 33% of patients and migraine and head trauma in 6% each. No associated conditions were found in 52%. Of the 15 patients with follow-up, 20% had a few more events of "Alice in Wonderland" syndrome or "Alice in Wonderland"-like syndrome, which eventually stopped after the initial diagnosis; 40% had no more events, and 40% were still having "Alice in Wonderland" syndrome or "Alice in Wonderland"-like syndrome symptoms at the time of the interview, while four patients (27%) developed migraines and one patient (7%) seizures since the diagnosis. CONCLUSION: "Alice in Wonderland" syndrome and "Alice in Wonderland"-like syndrome typically affect young children, and the most common visual complaints are micropsia and teleopsia. The most common associated condition is infection, but half of these individuals have no obvious trigger. Magnetic resonance imaging and electroencephalography are not helpful. The symptoms of "Alice in Wonderland" syndrome and "Alice in Wonderland"-like syndrome usually resolve, but in more than one third of the cases, they continue. One quarter of patients without a history of migraine may subsequently develop migraine.

Alice in wonderland and other migraine associated phenomena-evolution over 30 years after headache diagnosis.

BACKGROUND: The International Classification of Headache Disorders-III beta includes a number of episodic syndromes associated with migraine. Those who treat pediatric headaches are aware of a number of other phenomena (such as the Alice in Wonderland syndrome) which are thought to occur as precursors of migraine. There is no available data on the course of these phenomena over the decades following childhood headache diagnosis. METHODS: Patients who were observed by one of the authors in 1983 were contacted by telephone in 1993, 2003, and 2013. Details were gathered regarding the presence and characteristics of ongoing headaches and about the presence of sleepwalking, motion sickness, and distortions of either time or space perceptions. RESULTS: Twenty-eight patients were monitored in 1993, 2003, and 2013. Ongoing headaches were reported by 71%. Sleepwalking was only present in one patient in 2013. More than a third still complained of motion sickness, and more than one quarter still experienced distortions of time. Distortions of space were still reported by nearly 20%. Reporting any of these phenomena was not consistent over time, with some patients reporting distortions for the first time in adulthood. There was no clear correlation with migraine, and patients with tension-type headaches also reported the phenomena. CONCLUSIONS: Motion sickness and distortions of both space and time persist into the fifth decade for many patients initially observed with headaches in childhood. The correlation with migraine is less clear than previously thought.