Alice in wonderland syndrome

Reyhaneh Khosravi zadeh haghighi,1,* Elaheh malek makan,2

1. Zand Institute of Higher Education
2. Zand Institute of Higher Education



Alice in wonderland syndrome (aiws) is a rare perceptual disorder, chiefly affecting the integration mechanisms among sensory associative cortices that are involved in the development of internal-external relationship. cardinal alteration of aiws is the unbalance between the self-representation and the external world, so that patients with aiws may have an erroneous perception of their body size with respect to the external environment or a rework of the external space to their own body reference. aiws remains a poorly known and probably misdiagnosed syndrome. this variableness in the diagnostic process is due to the fact that no univocally accepted diagnostic criteria for this disease have been made. aiws can occur at any age but mostly in children and it is not solely related to one medical condition but rather can have several causes. however, a link with migraine seems to be suggested by the high frequency of cooccurrence of the two diseases. in this review, we will discuss the original description of perceptual alterations by lewis carroll and will frame them into the main clinical features of aiws as presented in several case reports. a main topic will be the critical review of available classifications. since no clear pathophysiological mechanism for aiws is known, an anatomical study of correlation will be presented considering all cases in which neuroimaging data were available.


A systematic literature search was carried out in pubmed (until june 2015) using the search terms “alice in wonderland syndrome,” “syndrome of alice in wonderland,” and variants thereof. included were articles in the english, dutch, german, french, spanish, and italian languages. all cross-references were checked systematically. in this article, symptoms of aiws experienced by patients diagnosed with a neurologic, psychiatric, or other medical condition are referred to as “clinical,” and symptoms of aiws experienced by individuals in the general population who have not sought medical attention are referred to as “nonclinical.”


Ymptoms of aiws usually resolve spontaneously or after treatment of an underlying cause. in our case, the successful treatment of severe malaria coincided with a complete regression of aiws whose aetiology was poorly-elucidated given the resource constraints. in any case, the good outcome of our patient aligns with previous reports on acute aiws that highlight a limited need for excessive investigation and treatment modalities which are, in passing, predominantly unaffordable in resource-limited primary care settings.


Clinical suspicion of an aiws warrants careful auxiliary investigations and – whenever necessary – treatment. the aiws should not be confused with schizophrenia spectrum disorders and other perceptual disorders, and it deserves to be included in the research agenda of international classifications such as the dsm and icd.


Body schema illusion, derealisation, macropsia, metamorphopsia, micropsia