Alice in Wonderland syndrome, also known as Todd's syndrome or lilliputian hallucinations,
is a disorienting neurological condition that affects human perception.
Sufferers experience dysmetropsia or size distortion of other sensory modalities.
A temporary condition, it is often associated with migraines, brain tumors, and the use
of psychoactive drugs.
It can also present as the initial sign of the Epstein–Barr virus.
Anecdotal reports suggest that the symptoms of AIWS are fairly common in childhood, with
many people growing out of them in their teens.
It appears 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 flow in the parts of the brain that process visual perception and
texture.
Epidemiology The age of Alice-in-Wonderland sufferers ranges
from childhood to early or late 20s.
Some still suffer in their 70s.
History The syndrome is sometimes called Todd's syndrome,
in reference to an influential description of the condition in 1955 by Dr. John Todd,
a British psychiatrist who was Consultant Psychiatrist at High Royds Hospital at Menston
in West Yorkshire.
Todd discovered that several of his patients experienced severe migraine headaches causing
them to see and perceive objects as greatly out of proportion.
They suffered 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
eyesight, 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.
Since Lewis Carroll had been a well-known migraine sufferer with similar symptoms, Todd
speculated that Carroll had used his own migraine experiences as a source of inspiration for
his famous 1865 novel Alice’s Adventures in Wonderland.
Carroll’s diary reveals that in 1856 he consulted William Bowman, an eminent ophthalmologist,
about the visual manifestations of the migraines he regularly experienced.
Since Carroll had suffered from these migraine symptoms for years before writing Alice’s
Adventures, it seemed reasonable that Carroll had used his experiences as inspiration.
Signs and symptoms For the AIWS sufferer, the optical system
is entirely physically normal.
The AIWS involves a change in perception as opposed to a malfunction of the eyes themselves.
The hallmark sign of AIWS is a migraine, and AIWS may in part be caused by the migraine.
AIWS affects the sufferer's sense of vision, sensation, touch, and hearing, as well as
one's own body image.
A prominent and often disturbing symptom is that of altered body image: the sufferer may
find that he or she is confused as to the size and shape of parts 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.
Also, patients with certain neurological diseases have experienced similar visual hallucinations.
These hallucinations are called "Lilliputian," which means that objects appear either smaller
or larger than they actually are.
Patients may experience either micropsia or macropsia.
Micropsia is an abnormal visual condition, usually occurring in the context of visual
hallucination, in which affected persons see objects as being smaller than those objects
actually are.
Macropsia is a condition where the individual sees everything larger than it actually is.
The relationship, if any, between the syndrome and mononucleosis remains unknown.
One 17-year-old male described his odd symptoms.
He said, "quite suddenly objects appear small and distant or large and close.
I feel as I am getting shorter and smaller "shrinking" and also the size of persons are
not longer than my index finger.
Sometimes I see the blind in the window or the television 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 migrainous headache associated with eye redness, flashes
of lights and a feeling of giddiness.
I am always conscious to the intangible changes in myself and my environment."
The eyes themselves are normal, but the sufferer 'sees' objects with the wrong size or shape
or finds that perspective is incorrect.
This can mean that people, cars, buildings, etc., look smaller or larger than they should
be, or that distances look incorrect; for example a corridor may appear to be very long,
or the ground may appear too close.
The sufferer may also lose a sense of time, a problem similar 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, leading to severe, overwhelming
disorientation.
This can then cause the sufferer 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.
Diagnosis AIWS is a disturbance of perception rather
than a specific physiological change to the body's systems.
The diagnosis 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.
Another symptom of AIWS is sound distortion, such as every little movement making a clattering
sound.
This can cause sufferers to experience paranoia.
Prognosis Whatever the cause, the distortions can recur
several times a day and may take some time to abate.
Understandably, the sufferer can become alarmed, frightened, even panic-stricken.
The symptoms of the syndrome themselves are not harmful and are likely to disappear with
time.
See also Charles Bonnet syndrome
References