Unusual Presentation of Alice in Wonderland Syndrome: A Case Report and Literature Review
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…
2025 4,892 reads 0 citations
Case Reports
Unusual Presentation of Alice in Wonderland Syndrome: A Case Report and Literature Review
IntroductionAlice 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 presentationA 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 reviewSixteen 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.
ConclusionAlice 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.
Keywords Alice in Wonderland Syndrome Migraine Perceptual distortion Visual distortions All subjects
Barw Medical Journal. 2025;3(4):66–70