Shin C Beh1, Shamin Masrour1, Stacy V Smith1, Deborah I Friedman1. 1. Departments of Neurology (SCB, SM, DIF) and Ophthalmology (DIF), University of Texas Southwestern Medical Center at Dallas; and Department of Neurology (SVS), Houston Methodist Neurological Institute, TX.
Abstract
BACKGROUND: Alice in Wonderland syndrome (AIWS) is a rare sensory perception disorder, most often caused by migraine in adults. We aimed to characterize the clinical characteristics of AIWS in a cohort of vestibular migraine (VM) patients. METHODS: Retrospective chart review of patients diagnosed with VM seen between August 2014 and January 2018. RESULTS: Seventeen patients were identified (10 women) with a median age at onset of 45 years (range 15-61 years), and median age at presentation of 49 years (range 17-63 years). Eighty-two percent reported 1 AIWS symptom, 12% reported 3 symptoms, and 6% described 2 symptoms. The most common symptom was visual distortions (47%), followed by extrapersonal misperceptions (41%) and somesthetic distortions (29%). Most AIWS occurred during VM episodes (77%). Eleven patients were seen in follow-up; 10 described complete or partial resolution of both AIWS and VM with migraine preventive therapy, while 1 experienced complete resolution of VM but continued to have AIWS. Neuro-otologic abnormalities improved in 2 patients. CONCLUSIONS: This study characterizes the clinical features of AIWS in patients with VM. We observed several rare and highly unusual AIWS misperceptions (frosted-glass vision, underwater vision, dolly zoom effect, sensation of the brain coming out of the head, closed-eye visual hallucinations, and headlight glare-induced marco/microsomatognosia), and resolution or improvement in AIWS and VM with migraine preventive treatment.
BACKGROUND: Alice in Wonderland syndrome (AIWS) is a rare sensory perception disorder, most often caused by migraine in adults. We aimed to characterize the clinical characteristics of AIWS in a cohort of vestibular migraine (VM) patients. METHODS: Retrospective chart review of patients diagnosed with VM seen between August 2014 and January 2018. RESULTS: Seventeen patients were identified (10 women) with a median age at onset of 45 years (range 15-61 years), and median age at presentation of 49 years (range 17-63 years). Eighty-two percent reported 1 AIWS symptom, 12% reported 3 symptoms, and 6% described 2 symptoms. The most common symptom was visual distortions (47%), followed by extrapersonal misperceptions (41%) and somesthetic distortions (29%). Most AIWS occurred during VM episodes (77%). Eleven patients were seen in follow-up; 10 described complete or partial resolution of both AIWS and VM with migraine preventive therapy, while 1 experienced complete resolution of VM but continued to have AIWS. Neuro-otologic abnormalities improved in 2 patients. CONCLUSIONS: This study characterizes the clinical features of AIWS in patients with VM. We observed several rare and highly unusual AIWS misperceptions (frosted-glass vision, underwater vision, dolly zoom effect, sensation of the brain coming out of the head, closed-eye visual hallucinations, and headlight glare-induced marco/microsomatognosia), and resolution or improvement in AIWS and VM with migraine preventive treatment.
Authors: Olaf Blanke; Christine Mohr; Christoph M Michel; Alvaro Pascual-Leone; Peter Brugger; Margitta Seeck; Theodor Landis; Gregor Thut Journal: J Neurosci Date: 2005-01-19 Impact factor: 6.167
Authors: K Jáuregui-Renaud; F Y P Sang; M A Gresty; D A Green; A M Bronstein Journal: J Neurol Neurosurg Psychiatry Date: 2007-06-19 Impact factor: 10.154
Authors: F Yen Pik Sang; K Jáuregui-Renaud; D A Green; A M Bronstein; M A Gresty Journal: J Neurol Neurosurg Psychiatry Date: 2006-02-07 Impact factor: 10.154