Alice in Wonderland syndrome

From Wikipedia, the free encyclopedia

Alice-in-Wonderland syndrome (AIWS, named after the novel written by Lewis Carroll), also known
as Todd's syndrome[1] or lilliputian hallucinations, is a disorienting neurological condition that
affects human perception. Sufferers may experience micropsia, macropsia, or size distortion of other sensory
modalities. A temporary condition, it is often associated with migraines, brain tumors, and the use of
psychoactive drugs. It can also present as the initial sign of the Epstein-Barr
Virus (see mononucleosis).[2] Anecdotal reports suggest that the symptoms of AIWS are fairly common in
childhood,[citation needed] with many people growing out of them in their teens. It appears that AIWS is also a
common experience at sleep onset. Alice in Wonderland Syndrome can be caused by abnormal amounts of
electrical activity causing abnormal blood flow in the parts of the brain that process visual perception and
texture.[3]

Contents

[hide]

1 Epidemiology

2 History

3 Signs and symptoms

4 Diagnosis

5 Prognosis

6 See also

7 References

Epidemiology[edit]

The age of Alice-in-Wonderland sufferers ranges from childhood to early or late 20s. Some still suffer in their
70s.

History[edit]

Alice in Wonderland Syndrome (micropsia and macropsia) is experienced after ingestion of muscimol. The
famous hallucinogenic that Alice from Alice in Wonderland eats ("red and white toadstool") is Amanita
muscaria or Fly Agaric, which contains the psychoactive alkaloid muscimol.

Alice in Wonderland Syndrome is sometimes called Todds syndrome, in reference to an influential description
of the condition by John Todd (1914-1987) in 1955, a British psychiatrist who worked in Yorkshire.[4][5] Todd
discovered that several patients under his care experienced severe migraine headaches causing them to see
and perceive objects as greatly out of proportion. They suffered from altered sense of time and touch, as well
as distorted looks of their own body images. Besides migraine headaches, none of these patients had brain
tumors, damage to eyesight, or mental illnesses that can cause similar symptoms. They were also all able to
think lucidly and could distinguish hallucinations from reality - it was all about skewed senses of
perception.[6] Since Lewis Carroll was a well-known migraine sufferer with similar symptoms, John Todd
speculated that Carroll had used his own migraine experiences as a source of inspiration for his famous 1865
novelAlices Adventures in Wonderland. Carrolls diary reveals that in 1856 he consulted William Bowman, an
eminent ophthalmologist about the visual manifestations of migraine he regularly experienced. [7] Since Lewis
Carroll suffered from these symptoms of migraine years before writing Alices Adventures in Wonderland, it is
reasonable to presume that Carroll used his experiences as inspiration.

Signs and symptoms[edit]

For the AIWS sufferer, the optical system is entirely physically normal. The AIWS involves a change in
perception as opposed to a malfunction of the eyes themselves. The hallmark sign of AIWS is a migraine, and
AIWS may in part be caused by the migraine.[citation needed] AIWS affects the sufferer's sense of vision, sensation,
touch, and hearing, as well as one's own body image.

A prominent and often disturbing symptom is that of altered body image: the sufferer may find that he or she is
confused as to the size and shape of parts of (or all of) his/her body. Alice in Wonderland syndrome involves
perceptual distortions of the size or shape of objects. Other possible causes and/or signs of association with
the syndrome are migraines, use of hallucinogenic drugs, and infectious mononucleosis.[8]

Also, patients with certain neurological diseases have experienced similar visual hallucinations. [9] These
hallucinations are called "Lilliputian," which means that objects appear either smaller or larger than they
actually are.[10]

Patients may experience either micropsia or macropsia. Micropsia is an abnormal visual condition, usually
occurring in the context of visual hallucination, in which affected persons see objects as being smaller than
those objects actually are.[11] Macropsia is a condition where the individual sees everything larger than it
actually is.[12]

The relationship, if any, between the syndrome and mononucleosis remains unknown.[13] One 17-year-old male
described his odd symptoms. He said, "quite suddenly objects appear small and distant (teliopsia) or large and
close (peliopsia). I feel as I am getting shorter and smaller "shrinking" and also the size of persons are not
longer than my index finger (a lilliputian proportion). Sometimes I see the blind in the window or the television
getting up and down, or my leg or arm is swinging. I may hear the voices of people quite loud and close or faint
and far. Occasionally, I experience attacks of migrainous headache associated with eye redness, flashes of
lights and a feeling of giddiness. I am always conscious to the intangible changes in myself and my
environment." [14]

The eyes themselves are normal, but the sufferer 'sees' objects with the wrong size or shape or finds that
perspective is incorrect. This can mean that people, cars, buildings, etc., look smaller or larger than they should
be, or that distances look incorrect; for example a corridor may appear to be very long, or the ground may
appear too close.

The sufferer may also lose a sense of time, a problem similar to the lack of spatial perspective. That is, time
seems to pass very slowly, akin to an LSD experience. The lack of time, and space, perspective leads to a
distorted sense of velocity. For example, one could be inching along ever so slowly in reality, yet it would seem
as if one were sprinting uncontrollably along a moving walkway, leading to severe, overwhelming disorientation.
This can then cause the sufferer to feel as if movement, even within his or her own home, is futile.

In addition, some people may, in conjunction with a high fever, experience more intense and overt
hallucinations, seeing things that are not there and misinterpreting events and situations.

Other minor or less common symptoms may include loss of limb control and general dis-coordination, memory
loss, lingering touch and sound sensations, and emotional experiences.[15]

Diagnosis[edit]

AIWS is a disturbance of perception rather than a specific physiological change to the body's systems. The
diagnosis can be presumed when other physical causes have been ruled out and if the patient presents
symptoms along with migraines and complains of onset during the day (although it can occur at night). Another
symptom of AIWS is sound distortion, such as every little movement making a clattering sound. This can cause
sufferers to experience paranoia.[citation needed]

Prognosis[edit]

Whatever the cause, the distortions can recur several times a day and may take some time to abate.
Understandably, the sufferer can become alarmed, frightened, even panic-stricken.[citation needed] The symptoms
of the syndrome themselves are not harmful and are likely to disappear with time.

See also[edit]

Charles Bonnet syndrome

Muscimol
References[edit]
1. Jump up^ Longmore, Murray; Ian Wilkinson, Tom Turmezei, Chee Kay Cheung (2007). Oxford Handbook

of Clinical Medicine. Oxford. p. 686. ISBN 0-19-856837-1.

2. Jump up^ Cinbis M, Aysun S; M Cinbis and S Aysun (May 1992). "Alice in Wonderland syndrome as an

initial manifestation of Epstein-Barr virus infection.". Br J Ophthalmol 76 (5):

316.doi:10.1136/bjo.76.5.316. PMC 504267. PMID 1390519.

3. Jump up^ Feldman, Caroline (April 7, 2008). "A Not So Pleasant Fairy Tale: Investigating Alice in

Wonderland Syndrome". Serendip. Serendip Studio, Bryn Mawr College. Archived from the original on May

7, 2013. Retrieved 25 November 2011.

4. Jump up^ Todd, John (1955). "The syndrome of Alice in Wonderland". Canadian Medical Association
Journal 73 (9): 701704. PMC 1826192.

5. Jump up^ Lanska, JR Lanska DJ. (2013). "Alice in Wonderland Syndrome: somesthetic vs visual
perceptual disturbance". Neurology 80 (13): 1262

1264.doi:10.1212/WNL.0b013e31828970ae. PMID 23446681.

6. Jump up^ DEA, Servizio. "The Alice in Wonderland Syndrome". PubMed. Retrieved 2013-09-15.

7. Jump up^ Martin, R. "Through the Looking Glass, Another Look at Migraine". Retrieved 2013-09-15.

8. Jump up^ "Alice in Wonderland syndrome." Taber's Cyclopedic Medical Dictionary. Philadelphia: F.A.Davis

Company, 2009. Credo Reference. Web. 24 September 2012.

9. Jump up^ "Alice in Wonderland syndrome." Mosby's Dictionary of Medicine, Nursing, & Health

Professions. Philadelphia: Elsevier Health Sciences, 2009. Credo Reference. Web. 24 September 2012.

10. Jump up^ "Hallucinations." The Concise Corsini Encyclopedia of Psychology and Behavioral Science.

Hoboken: Wiley, 2004. Credo Reference. Web. 24 September 2012.

11. Jump up^ "micropsia." Mosby's Emergency Dictionary. Philadelphia: Elsevier Health Sciences, 1998.

Credo Reference. Web. 24 September 2012.

12. Jump up^ "macropsia". Collins English Dictionary. London: Collins, 2000. Credo Reference. Web. 24

September 2012.

13. Jump up^ Lahat, E; Berkovitch, Barr (November 1999). "Abnormal visual evoked potentials in children with

"Alice in Wonderland" syndrome due to infectious mononucleosis.". Journal of Child Neurology 14 (11):

7325.

14. Jump up^ Hamed, Sherifa (1/6/2010). A migraine variant with abdominal colic and Alice in wonderland

syndrome: a case report and review. doi:10.1186/1471-2377-10-2.

15. Jump up^ "Alice in Wonderland Syndrome". h2g2.com. September 21, 2009. Retrieved 4 January 2014.