Alice in Wonderland syndrome

Alice in Wonderland syndrome (AiWS), also known as Todd's syndrome or dysmetropsia, is a disorienting neuropsychological condition that affects perception. People may experience distortions in visual perception such as micropsia (objects appearing small), macropsia (objects appearing large), pelopsia (objects appearing to be closer than they are), or teleopsia (objects appearing to be further away than they are). Size distortion may occur in other sensory modalities as well.

Alice in Wonderland Syndrome (AWS) is typically reported in neurological and psychiatric disorders.

Entezami et al. from the Department of Neurosurgery, Albany Medical College, present a patient who developed symptoms of AWS post-operatively.

A 48-year-old male presented in shunt failure, attributed to a proximal catheter occlusion. Operative revision with replacement of the proximal catheter was performed without incident. Post-operatively he complained of visual disturbances, including the perception that people had small heads on little bodies. Symptoms resolved post-operatively.

The patient's symptoms were diagnosed as a transient episode of AWS. This was attributed to manipulation of the parieto-occipital cortex during the revision. The local inflammatory response from manipulation of that area is thought to have caused our patient's symptoms.

Visual disturbances caused by lesions along the optic radiations are common findings for neurosurgery patients, though AWS following surgical intervention has not previously been reported ¹⁾.