Alice in Wonderland syndrome
Alice in Wonderland syndrome (AIWS, named af-
ter the novel written by Lewis Carroll), also known
as Todds syndrome[1] or lilliputian hallucinations,
is a disorienting neurological condition that aects
human perception. Suerers experience dysmetropsia
(micropsia, macropsia, pelopsia, teleopsia) or size dis-
tortion of other sensory modalities. A temporary con-
dition, it is often associated with migraines, brain tu-
mors, and the use of psychoactive drugs. It can also
present as the initial sign of the EpsteinBarr virus (see
mononucleosis).[2] Anecdotal reports suggest that the
symptoms of AIWS are fairly common in childhood, with
many people growing out of them in their teens. It ap-
pears 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 ow in the parts of the brain that process visual per-
ception and texture.[3]
1 Epidemiology
The age of Alice-in-Wonderland suerers ranges from
childhood to early or late 20s. Some still suer in their
70s.
2 History
The syndrome is sometimes called Todds syndrome, in
reference to an inuential description of the condition
in 1955 by Dr. John Todd (1914-1987), who was a
British Consultant Psychiatrist at High Royds Hospital
at Menston in West Yorkshire.[4][5][6] Todd discovered
that several of his patients experienced severe migraine
headaches causing them to see and perceive objects as
greatly out of proportion. They suered from altered
sense of time and touch, as well as distorted perceptions
of their own body. Although having migraine headaches,
none of these patients had brain tumours, damaged eye-
sight, or mental illness that could have caused similar
symptoms. They were also all able to think lucidly and
could distinguish hallucinations from reality. But their
perceptions were skewed.[7] Since Lewis Carroll had been
a well-known migraine suerer with similar symptoms,
Todd speculated that Carroll had used his own migraine
experiences as a source of inspiration for his famous 1865
novel Alices Adventures in Wonderland. Carrolls diary
reveals that in 1856 he consulted William Bowman, an
eminent ophthalmologist, about the visual manifestations
of the migraines he regularly experienced.[8] Since Car-
roll had suered from these migraine symptoms for years
before writing Alices Adventures, it seemed reasonable
that Carroll had used his experiences as inspiration.
3 Signs and symptoms
For the AIWS suerer, the optical system is entirely
physically normal. The AIWS involves a change in per-
ception as opposed to a malfunction of the eyes them-
selves. The hallmark sign of AIWS is a migraine, and
AIWS may in part be caused by the migraine. AIWS af-
fects the suerers sense of vision, sensation, touch, and
hearing, as well as ones own body image.
A prominent and often disturbing symptom is that of al-
tered body image: the suerer may nd 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.[9]
Also, patients with certain neurological diseases have ex-
perienced similar visual hallucinations.[10] These halluci-
nations are called "Lilliputian, which means that objects
appear either smaller or larger than they actually are.[11]
Patients may experience either micropsia or macropsia.
Micropsia is an abnormal visual condition, usually occur-
ring in the context of visual hallucination, in which af-
fected persons see objects as being smaller than those ob-
jects actually are.[12] Macropsia is a condition where the
individual sees everything larger than it actually is.[13]
The relationship, if any, between the syndrome and
mononucleosis remains unknown.[14] One 17-year-old
male described his odd symptoms. He said, quite sud-
denly 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 nger (a lilliputian proportion).
Sometimes I see the blind in the window or the televi-
sion 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 mi-
grainous headache associated with eye redness, ashes of
lights and a feeling of giddiness. I am always conscious
to the intangible changes in myself and my environment.
1
2 7 REFERENCES

[15]
The eyes themselves are normal, but the suerer 'sees ob-
jects with the wrong size or shape or nds that perspective
is incorrect. This can mean that people, cars, buildings,
etc., look smaller or larger than they should be, or that dis-
tances look incorrect; for example a corridor may appear
to be very long, or the ground may appear too close.
The suerer may also lose a sense of time, a problem sim-
ilar 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, lead-
ing to severe, overwhelming disorientation. This can then
cause the suerer 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.[16]
7 References
[1] Longmore, Murray; Ian Wilkinson; Tom Turmezei; Chee
Kay Cheung (2007). Oxford Handbook of Clinical
Medicine. Oxford. p. 686. ISBN 0-19-856837-1.
[2] Cinbis M, Aysun S; M Cinbis; S Aysun (May 1992).
Alice in Wonderland syndrome as an initial manifesta-
tion of Epstein-Barr virus infection.. Br J Ophthalmol
76 (5): 316. doi:10.1136/bjo.76.5.316. PMC 504267.
PMID 1390519.
[3] Feldman, Caroline (April 7, 2008). A Not So Pleas-
ant Fairy Tale: Investigating Alice in Wonderland Syn-
drome. Serendip. Serendip Studio, Bryn Mawr College.
Archived from the original on May 7, 2013. Retrieved 25
November 2011.
[4] Todd, John (1955). The syndrome of Alice in Won-
derland. Canadian Medical Association Journal 73 (9):
701704. PMC 1826192.
[5] Lanska, JR Lanska DJ. (2013). Alice in Wonder-
land Syndrome: somesthetic vs visual perceptual
disturbance. Neurology 80 (13): 12621264.
doi:10.1212/WNL.0b013e31828970ae. PMID
23446681.
[6] The Career of Dr John Todd And Drug Addiction Case
Studies. Highroydshospital.com. Retrieved 2014-06-04.

[7] DEA, Servizio. The Alice in Wonderland Syndrome.

4 Diagnosis
AIWS is a disturbance of perception rather than a spe-
cic physiological change to the bodys systems. The di-
agnosis 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 (al- [10] Alice in Wonderland syndrome. Mosbys Dictionary of
though it can occur at night). Another symptom of AIWS
is sound distortion, such as every little movement making
a clattering sound. This can cause suerers to experience
paranoia.
PubMed. Retrieved 2013-09-15.
[8] Martin, R. Through the Looking Glass, Another Look at
Migraine. Retrieved 2013-09-15.
[9] Alice in Wonderland syndrome. Tabers Cyclopedic
Medical Dictionary. Philadelphia: F.A.Davis Company,
2009. Credo Reference. Web. 24 September 2012.
Medicine, Nursing & Health Professions. Philadelphia:
Elsevier Health Sciences, 2009. Credo Reference. Web.
24 September 2012.
[11] Hallucinations. The Concise Corsini Encyclopedia of
Psychology and Behavioral Science. Hoboken: Wiley,
2004. Credo Reference. Web. 24 September 2012.

5 Prognosis [12] micropsia. Mosbys Emergency Dictionary. Philadel-

phia: Elsevier Health Sciences, 1998. Credo Reference.
Web. 24 September 2012.
Whatever the cause, the distortions can recur several
times a day and may take some time to abate. Under- [13] macropsia. Collins English Dictionary. London:
standably, the suerer can become alarmed, frightened, Collins, 2000. Credo Reference. Web. 24 September
even panic-stricken. The symptoms of the syndrome 2012.
themselves are not harmful and are likely to disappear [14] Lahat, E; Berkovitch, Barr (November 1999). Ab-
with time. normal visual evoked potentials in children with Al-
ice in Wonderland syndrome due to infectious mononu-
cleosis.. Journal of Child Neurology 14 (11): 7325.
doi:10.1177/088307389901401109.
6 See also
[15] Hamed, Sherifa (6 January 2010). A migraine variant
with abdominal colic and Alice in wonderland syndrome:
Charles Bonnet syndrome a case report and review. doi:10.1186/1471-2377-10-2.
 3

[16] Alice in Wonderland Syndrome. h2g2.com. September

21, 2009. Retrieved 4 January 2014.
4 8 TEXT AND IMAGE SOURCES, CONTRIBUTORS, AND LICENSES

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