Alice in Wonderland syndrome

Alice in Wonderland syndrome, also known as Todd syndrome, is a rare condition affecting the sensory inputs in the brain.

Epidemiology

Alice in Wonderland syndrome most common in children with over two-third of cases occurring in the pediatric demographic ¹.

Clinical presentation

Alice in Wonderland syndrome encompasses a wide range of symptoms ¹. Common symptoms include ¹:

• metamorphopsia, e.g. macropsia, micropsia, teleopsia

• partial or total body micro- or macrosomatognosia

• quick-motion phenomenon

• derealisation

Pathology

The pathogenesis is unclear and there are a wide range of possible etiologies ¹.

Etiology

Common causes include:

• migraine with aura

• central nervous system infections (e.g. Epstein-Barr virus, influenza A, H1N1, varicella, lyme disease, scarlet fever)

• seizures/epilepsy (e.g. temporal lobe epilepsy)

• focal central nervous system lesions (e.g. stroke, trauma, brain tumors)

• psychiatric conditions (e.g. schizoaffective disorder, schizophrenia)

• recreational drugs (e.g. lysergic acid diethylamide (LSD), toluene)

• degenerative brain diseases (e.g. Creutzfeldt-Jakob disease)

• medications (e.g. topiramate, montelukast, dextromethorphan)

Radiographic features

Radiographic features can vary immensely depending on the etiology. The role of imaging is to assess for any structural cause.

Treatment and prognosis

Management depends on the underlying etiology, which in many cases, is self-limiting.

History and etymology

Alice in Wonderland syndrome was coined by John Todd (1914-1987), a British psychiatrist ¹. The name refers to the classic work of fiction "Alice's Adventures in Wonderland" by Lewis Carroll ^1,2.