Alice In Wonderland Syndrome


What is Alice In Wonderland Syndrome?

Alice in Wonderland Syndrome (AIWS) is also known as Todd’s Syndrome as it was first identified by Dr John Todd, a British psychiatrist, who noticed that the anecdotes of the disease resembled the character of Alice Lindell from Lewis Carrol’s famous novel Alice in Wonderland.

Alice in Wonderland Syndrome is a rare disease that causes temporary episodes of distorted perception and disorientation. It is an alteration of visual perception wherein the sizes of body parts or external objects are perceived incorrectly. Usually, such perceptions occur at night.

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What causes this syndrome is still unknown but a few researchers believe that it may be related to unusual electrical activity in the brain that causes abnormal blood flow to the parts of the brain, resulting in an altered visual perception. Few studies have shown that Alice in Wonderland Syndrome stems from infections occurring as a result of head trauma and migraines. Infact, migraine is considered to be the leading cause of this syndrome in adults. Vision, touch and hearing are also affected in individuals, causing a loss of time perception and a feeling of time passing slow.

There are many case reports that suggest a cluster of symptoms associated with Alice in Wonderland Syndrome where there may be a perception of things being physically larger or smaller in comparison to their surroundings. Some individuals may have an impression that their surroundings are growing or shrinking than them. Some people also believe that their surroundings are moving.

What is the Pathophysiology of This Syndrome?

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The Temporo-Parieto-Occipital (TPO) junction connects the temporo-occipital, parieto-occipital, and temporoparietal junctions where the visual and somatosensory information is integrated to generate the inner and external representation of self. Alice in Wonderland Syndrome attributes to the migrainous cortical dysfunction of the non-dominant parietal lobe. The electrical stimulation of the parietal lobe leads to distortion in the size and length of the image perceived. Decreased perfusion to the non-dominant parietal lobe during an attack leads to the perception of symptoms. In most cases, Alice in Wonderland Syndrome symptoms often precede a migraine attack.

What are the Causative Factors for Alice in Wonderland Syndrome?

The causative factors of Alice in Wonderland Syndrome can be grouped under the following types:

Conditions Infectious Diseases Intraparenchymal Haemorrhagic Stroke


  • Headaches
  • Migraine
  • Abdominal migraine
  • Cluster headache
  • Tension-type headache
  • Transient Headache and Neurological Deficits with Cerebrospinal Fluid Lymphocytosis (HaNDL Syndrome)
  •  Epilepsy
  • Temporal lobe epilepsy
  • Frontal lobe epilepsy


  • Epstein-Barr virus
  • Coxsackie B1 virus
  • Cytomegalovirus
  • Influenza A virus
  • Mycoplasma
  • Varicella-zoster
  • Typhoid encephalopathy
  • Lyme neuroborreliosis
  • Streptococcus pyogenes (scarlet fever and tonsillopharyngitis)
  • Parainfective vasculitis
  • Cerebrovascular diseases


  • Ischemic stroke
  • Cavernous angioma
  • Robin Hood syndrome
  • Pituitary infarction
  •  Other organic brain diseases
  • Acute disseminated encephalomyelitis
  • Glioblastoma
  •  Psychiatric disorders
  • Depressive disorder
  • Schizophrenia
  • Schizoaffective disorder


  • Dextromethorphan
  • Cough syrup (containing dihydrocodeine and DL-methyl-ephedrine)
  • Montelukast
  • Topiramate
  • LSD
  • Hallucinogen Persisting Perception Disorder (HPPD) after LSD withdrawal
  • Toluene-based solvent



What are the Symptoms of Alice in Wonderland Syndrome?

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The symptoms of patients suffering from Alice in Wonderland Syndrome may vary differently and the episodes can last from a few minutes to an hour. Some commonly occurring symptoms include:

  • Migraine

Patients may experience a subtype of migraine that can lead to an aura, visual derangements, hemi-cranial headaches, nausea and vomiting.

  • Size Distortion

Micropsia and macropsia may be observed wherein, the body or objects may appear smaller or grow larger. Other symptoms of size distortion include Achromatopsia (inability to perceive colour) and Dysmorphosia (causing preception of lines occurring as wavy). Individuals can also have a feeling of derealization, depersonalization, somatopsychic duality and alteration in the judgement of time.

  • Hallucinations

Size distortion can occur where objects appear to be near or growing larger than they are (Pelopsia) or objects growing smaller and farther away (called Telopsia). When time distortion occurs, the individual believes that time is passing very slow or too fast. In some cases, sound distortion can occur causing every sound to be loud and intrusive.

  • Loss of coordination

Involuntary movements of limbs and difficultly in the coordination of movements while walking can occur.

  • The feeling of derealization, depersonalization, somatopsychic duality
  • Alteration in the judgement of time
  • Lilliputianism (people appearing smaller)


What are the Risk Factors For Alice in Wonderland Syndrome?

Why some people develop this syndrome while others don’t is still a mystery. However, some risk factors that can increase an individual’s risk of developing the condition are:

  • Repeated attacks of migraine 
  • Epstein Barr Virus Infection
  • Infectious Mono Nuclueosis
  • Genetics 
  • Brain Tumor
  • Disseminated encephalomyelitis

What are the Complications of Alice in Wonderland Syndrome?

Patients with Alice in Wonderland Syndrome usually get better with time and very rarely complications arise from it. In most cases, migraine is the triggering factor and results in repeated episodes that take place over time. However, it has been noted that about one-third of the people without a history of migraine can also develop this condition.

How is Alice in Wonderland Syndrome Diagnosed?

If you observe any symptoms of Alice in Wonderland Syndrome in a patient, you can refer take a proper medical and family history of the patient. Though there are no specific tests or investigations that help you conclude the diagnosis of AIWS, some useful diagnostic aids like MRI scan, EEG, a blood test to detect the EBV or investigating further into factors that can cause or trigger symptoms may be done.

How is Alice in Wonderland Syndrome Treated?

There is no standard or prescribed treatment protocol for Alice in Wonderland Syndrome. Usually, drugs used to treat migraines such as anticonvulsants, antidepressants, calcium channel blockers, beta-blockers and other treatments like repetitive transcranial magnetic stimulation are used for effective resolution of the symptoms. If the causative factor of a patient’s AIWS is infections like the EBV, then appropriate treatment for the infection can help subside the symptoms. If stress is the causative factor for AIWS, the patient may be advised appropriate stress-relieving lifestyle methods like exercising, meditation, and yoga.

Alice in Wonderland Syndrome is not a serious issue but its symptoms can be bothersome and affect one’s daily life. Sometimes, patients may experience episodes for several days, and in some cases, they may not experience any symptoms for weeks or months together. Symptoms usually lessen over a period of time and may disappear completely by the time the individual reaches puberty.

Featured Image Source: Image by Willgard Krause from Pixabay
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About the author

Dr.Nikita Pawar is a General Practitioner by profession and has completed her (MBBS PGDCR). She has previously worked in GMC Hospital Dubai & is currently attached to a hospital, corporate company and Clinics in Mumbai. She is passionate about medical article writing and always strives to maintain commitment towards achieving professional growth as she transitions from one phase of her career to the next.



  • sunil magar April 14, 2021 at 8:19 pm

    nice article DR Nikitta

  • Ajit singh Bhoite April 14, 2021 at 9:23 pm

    I had this kind of disturbance about an year back when I had flutter problem which was cured with ablation in July last year.
    Some times when I used to getup from horizontal position to upright standing position without an interval, I used to have this feeling of buckling of knees and an aurea with blurred vision.
    When I discussed this problems with cardiologist,I has told to stop this kind of adrupt movements I was advised to give sufficient time so that the blood circulations reaches to brains in sufficient quantity.after that I did not these problems.
    Thanks Dr Nikita,it’s a very informative
    article.take care and stay safe.?