Barw Barw Medical Journal 2960-1959 2025 09 21 Unusual Presentation of Alice in Wonderland Syndrome: A Case Report and Literature Review 66 70 10.58742/bmj.vi.205 eng Yadgar N. Abbas Shahid Doctor Hemn Psychiatric Hospital, Qanat Street, Sulaymaniyah, Iraq. yadgar.abbas@gmail.com Meer M. Abdulkarim Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. meermohammedabdulkarim@gmail.com Mohammed Q. Mustafa Department of Medical Analysis, Tishk International University - Erbil, Erbil, Iraq. mohammed.mustafa@gmail.com Diyar A. Omar Medical Laboratory Technology, Shaqlawa Technical College, Erbil Polytechnic University, Erbil, Iraq. diyar.omar@gmail.com Kayhan A. Najar Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. kayhan.najar@gmail.com Karokh K. Mohammed Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. karokh.mohammed@gmail.com Sarhang Sedeeq Abdalla Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. sarhang.abdullah@gmail.com 2025 07 22 Introduction Alice in Wonderland Syndrome (AIWS) is an uncommon and frequently overlooked neuropsychiatric condition, marked by brief episodes of altered visual and somatosensory perception. This report presents a case of AIWS, highlighting the disorder's unusual nature. Case presentation A 21-year-old female sought evaluation due to episodic visual distortions and altered body perceptions lasting for six months, often accompanied by migraines. These episodes, including micropsia, macropsia, and derealization, typically occurred multiple times a week and lasted several minutes, with no clear triggers but worsening with stress or irregular sleep. She had a history of similar, less intense episodes in childhood. Neurological examination, MRI, EEG, and blood tests were all normal. She was diagnosed with AIWS related to her migraines and was prescribed propranolol, a stress management strategy, regular sleep, and cognitive behavioral therapy. Literature review Sixteen cases of AWIS were reviewed, of which only one had a family history of the condition. All of them experienced perceptual distortions, with macropsia and micropsia together appearing in eight cases, and hallucinations were present in four. Duration of symptoms ranged from one minute to one day. The triggering factors included Isolated cortical venous thrombosis and brucellosis. Treatments included lacosamide and paroxetine. Recurrence of symptoms was recorded in two patients. Conclusion Alice in Wonderland Syndrome is mostly a benign condition that can be resolved spontaneously or treated according to its associated cause; propranolol, improved sleep schedule, and cognitive behavioral therapy might yield good outcomes.