By Jason Burton, MD
VCU Health System
In this edition of syndromic, we explore Alice in Wonderland Syndrome (AIWS), an intriguing constellation of symptoms also known as Todd’s Syndrome. Though the neurologist Caro Lippman first described the condition in 1952, it was psychiatrist John Todd who popularized the term. He noted that the clinical presentation mirrored the bodily distortions experienced by Alice in Lewis Carroll’s Alice’s Adventures in Wonderland.
AIWS involves extraordinary sensory distortions. Patients may experience several types of hallucinations, including macropsia (objects appearing larger than they are), micropsia (objects appearing smaller), or distortions where objects appear significantly closer or further away than they actually are. These experiences often involve distortions in the individual’s own body size or their orientation in space. While some of these visual disturbances fall under the umbrella of Lilliputian hallucinations seen in other neuro syndromes, it is the patient’s own perceived bodily distortions that truly set AIWS apart. AIWS can affect hearing and touch, and it is often accompanied by depersonalization or derealization. These episodes are typically transient, lasting anywhere from a few minutes to several hours.
AIWS is not currently an official diagnosis in the DSM or the ICD. Its etiology is often linked to migraines, traumatic brain injury, encephalitis, or the use of hallucinogens. The symptoms likely stem from abnormal electrical activity in the parietal or occipital lobes. While exact prevalence is difficult to track due to the syndrome’s episodic nature, it is most common in adolescents and young adults and is experienced by an estimated 10% of migraine sufferers. Interestingly, Lewis Carroll was known to suffer from migraines. Dr. Todd speculated that Carroll’s own experiences with AIWS from migraines may have served as the creative influence for Alice’s surreal journey in his novel.
