Crash Cart Emergency Medicine

Down the Rabbit Hole: Alice in Wonderland Syndrome

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In this episode we’re going down the rabbit hole and talking about something rather bizarre. Alice in Wonderland Syndrome is a neurologic disorder causing perceptual disturbances. Dr. Zach Smith (EM/IM PGY-3) breaks down what we need to know.

Guest: Zach Smith, MD, MBA. Host: Kim Bambach, MD. Editors: Mike Prats, MD and Kim Bambach, MD.

Key Take-Aways:

  1. What is it? Alice in wonderland syndrome typically affects a pediatric population is an alteration of visual perception that may be associated with time distortion and derealization/depersonalization.
  2. Why does it happen? The underlying cause is unknown, but proposed causes include encephalitis, EBV infection, migraines.
  3. What’s the prognosis? Symptoms are typically episodic and the prognosis is usually favorable, but workup and treatment are aimed at more serious possible underlying causes (such as encephalitis).
  4. How are symptoms treated? Antipsychotics are considered ineffective. Symptoms are controlled with a migraine treatment regimen.

    5. References:

    1. Blom JD. Alice in Wonderland syndrome. Neurology Clinical Practice. 2016;6(3):259-270. doi:10.1212/CPJ.000000000000025
    2. Shah A, Magaña SM, E. Youssef P. Do You See What I See? A Case of Alice in Wonderland Syndrome With EEG Correlate. Child Neurol Open. 2020;7:2329048X20932714. doi:10.1177/2329048X20932714
      3. ...more
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