Alice in Wonderland syndrome

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Alice in Wonderland syndrome (AIWS, named after the novel written by Lewis Carroll), also known as Todd's syndrome[1] or lilliputian hallucinations, is a disorienting neurological condition that affects human perception. Sufferers experience dysmetropsia (micropsia, macropsia, pelopsia, teleopsia) 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 (see mononucleosis).[2] Anecdotal reports suggest that the symptoms of AIWS are fairly common in childhood,[citation needed] with many people growing out of them in their teens. It appears that AIWS is also a common experience at sleep onset, and has been known to commonly arise due to a lack of sleep. 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.[3]


The age of Alice-in-Wonderland sufferers may generally be from childhood to late 20s. Some still suffer in their 70s.[citation needed]


The syndrome is sometimes called Todd's syndrome, in reference to an influential 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 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.[7] 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.[8] 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[edit]

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.[citation needed] 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 (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 experienced similar visual hallucinations.[10] These hallucinations 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 occurring in the context of visual hallucination, in which affected persons see objects as being smaller than those objects 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 suddenly 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 finger (a lilliputian proportion). 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." [15]

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.[16]


AIWS is a disturbance of perception rather than a specific physiological change to the body's systems. The diagnosis can be presumed when other causes have been ruled out and if the patient presents symptoms along with migraines and complains of onset during the day (although it can also occur at night). Another symptom of AIWS is sound distortion, such as every little movement making a clattering sound. This can cause sufferers to experience paranoia.[citation needed]


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.[citation needed] The symptoms of the syndrome themselves are not harmful and are likely to disappear with time.

See also[edit]


  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 manifestation 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 Pleasant Fairy Tale: Investigating Alice in Wonderland Syndrome". 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 Wonderland". Canadian Medical Association Journal 73 (9): 701–704. PMC 1826192. PMID 13304769. 
  5. ^ Lanska, JR Lanska DJ. (2013). "Alice in Wonderland Syndrome: somesthetic vs visual perceptual disturbance". Neurology 80 (13): 1262–1264. doi:10.1212/WNL.0b013e31828970ae. PMID 23446681. 
  6. ^ "The Career of Dr John Todd And Drug Addiction Case Studies". Retrieved 2014-06-04. 
  7. ^ DEA, Servizio. "The Alice in Wonderland Syndrome". PubMed. Retrieved 2013-09-15. 
  8. ^ Martin, R. "Through the Looking Glass, Another Look at Migraine" (PDF). Retrieved 2013-09-15. 
  9. ^ "Alice in Wonderland syndrome." Taber's Cyclopedic Medical Dictionary. Philadelphia: F.A.Davis Company, 2009. Credo Reference. Web. 24 September 2012.
  10. ^ "Alice in Wonderland syndrome." Mosby's Dictionary of 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.
  12. ^ "micropsia." Mosby's Emergency Dictionary. Philadelphia: Elsevier Health Sciences, 1998. Credo Reference. Web. 24 September 2012.
  13. ^ "macropsia". Collins English Dictionary. London: Collins, 2000. Credo Reference. Web. 24 September 2012.
  14. ^ Lahat, E; Berkovitch, Barr (November 1999). "Abnormal visual evoked potentials in children with "Alice in Wonderland" syndrome due to infectious mononucleosis.". Journal of Child Neurology 14 (11): 732–5. doi:10.1177/088307389901401109. 
  15. ^ Hamed, Sherifa (6 January 2010). "A migraine variant with abdominal colic and Alice in wonderland syndrome: a case report and review". doi:10.1186/1471-2377-10-2. 
  16. ^ "Alice in Wonderland Syndrome". September 21, 2009. Retrieved 4 January 2014.