What are the other Names for this Condition? (Also known as/Synonyms)

• AIWS (Alice in Wonderland Syndrome)
• Dysmetropsia
• Todd's Syndrome

What is Alice in Wonderland Syndrome? (Definition/Background Information)

• Alice in Wonderland Syndrome (AIWS) is described as a rare neurological disorder in which an individual’s perception of the size and separation between objects is distorted; the objects may appear larger or smaller in size, and the distance between objects may appear smaller or larger than they actually are
• This condition is observed in both children and adults. The most common cause for Alice in Wonderland Syndrome being brain inflammation (encephalitis) and migraine respectively in children and adults. However, a host of other factors, such as infections, medication use, and brain tumors, are believed to be causative

Who gets Alice in Wonderland Syndrome? (Age and Sex Distribution)

• Only about 200 cases of Alice in Wonderland Syndrome have been recorded in the medical history
• Individuals of any age group may be affected; although, a large number of cases are reported in children and adolescents
• Both male and female gender may be affected
• Worldwide, individuals of all races and ethnicity may develop the condition

What are the Risk Factors for Alice in Wonderland Syndrome? (Predisposing Factors)

A host of predisposing factors for Alice in Wonderland Syndrome are reported and these include:

• Encephalitis or brain inflammation (usually in children)
• Migraine (usually in adults)
• Epilepsy
• Encephalopathy from a variety of causes
• Traumatic brain injury (TBI)
• Brain tumors
• Brain aneurysms
• Psychiatric disorders such as schizophrenia, depression, and depersonalization disorder
• Use of recreational drugs such as LSD, cocaine, or marijuana
• Infectious diseases that include:
  • Chickenpox
  • Coxsackievirus infection
  • Cytomegalovirus infection
  • Epstein Barr virus infection
  • H1N1 infection
  • Infectious mononucleosis
  • Influenza
  • Lyme disease
  • Scarlet fever
  • Shigellosis
  • Typhoid fever
• Use of certain medications
• Creutzfeldt-Jakob disease (CJD)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Alice in Wonderland Syndrome? (Etiology)

• Alice in Wonderland Syndrome (AIWS) is an acquired disorder that is believed to develop following an injury to a complex region of the brain known as the temporo-parieto-occipital (TPO) junction
• The TPO junction is the site of visual and sensory information process. A trauma to the region, from a variety of factors, may cause its dysfunction resulting in AIWS
• The factors causing the condition (damage to brain) may include migraine headaches, brain infections and lesions, medication side effects, trauma to the brain, and use of illegal drugs, among others

What are the Signs and Symptoms of Alice in Wonderland Syndrome?

The signs and symptoms of Alice in Wonderland Syndrome may differ from one individual to another, depending on the degree of severity of the condition. Many individuals are known to experience only a single type of distortion (either size of objects or distance between objects are altered).

The signs and symptoms may include:

• Visual distortions - such as seeing objects smaller or larger than normal, and perceiving objects as being closer or farther from each other
• Unable to differentiate between colors
• Visual hallucinations
• Sensing straight lines and edges as wavy
• Unable to judge time

Associated signs and symptoms of the underlying condition/disorder may also be observed.

How is Alice in Wonderland Syndrome Diagnosed?

• Alice in Wonderland Syndrome is diagnosed through physical exams and medical history evaluations (including seeking information about any trauma, use of medications, or other conditions)
• Neurological, motor skills, and cognitive assessment may be undertaken
• Electroencephalogram (EEG); it is not considered to be a useful diagnostic tool for AIWS
• Imaging studies including CT and MRI scans of the head and neck region may be undertaken based on the healthcare provider’s evaluation, in order to rule out other conditions

Further tests and procedures to diagnose the underlying causative condition may be needed.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Alice in Wonderland Syndrome?

The complications of Alice in Wonderland Syndrome may include:

• Difficulty in performing simple day to day tasks 
• Inability to walk on streets and roads; unable to cross the streets/roads
• Inability to participate in outdoor or sports activities
• Decreased quality of life

Complications arising from the underlying/associated condition, if any, may be noted.

How is Alice in Wonderland Syndrome Treated?

• Currently, there are no suitable treatments (including medications) available for Alice in Wonderland Syndrome (AIWS)
• Undertaking appropriate treatment of any associated brain (health) conditions is important to mitigate AIWS
• Regular medical screening at periodic intervals with tests and physical examinations are recommended

How can Alice in Wonderland Syndrome be Prevented?

Presently, it may not be possible to prevent Alice in Wonderland Syndrome. However, the following factors may help lower one’s risk for acquiring the same:

• Undertaking early diagnosis and adequate treatment of any brain disorder, including migraine headaches, brain tumors, and infections
• Avoiding the use of recreational drugs
• Wearing helmets and safety gear while participating in sports or while driving to prevent head injury

What is the Prognosis of Alice in Wonderland Syndrome? (Outcomes/Resolutions)

• The overall prognosis of Alice in Wonderland Syndrome primarily depends on the severity of the underlying condition, which may vary from one individual to another
• Nevertheless, in many individuals, the condition is self-limiting and normal visual (sensory) perception is restored within a short period of time

Additional and Relevant Useful Information for Alice in Wonderland Syndrome:

Please visit our Eye & Vision Health Center for more physician-approved health information:

https://www.dovemed.com/health-topics/vision-center/