Alice in Wonderland Syndrome Associated With a Temporo-Parietal Cavernoma (P5.124)
Jeffrey Kornitzer, Michelle Philips, David F. Marks, H. Lee, N. Souayah
Neurology April 6, 2015 DOI: 10.1212/wnl.84.14_supplement.p5.124 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | A 34-year-old pregnant woman with a right temporo-parietal cavernoma |
| Intervention | Levetiracetam |
| Key findings | The authors report that a woman with a right temporo-parietal cavernoma experienced Alice in Wonderland Syndrome symptoms that persisted despite EEG control of temporal lobe seizures and resolved completely after increasing levetiracetam. They argue an association between the cavernoma and her symptoms is reasonable, or alternatively that the symptoms could represent a prolonged postictal phenomenon following right temporal lobe seizures. |
Abstract
Objective: In this case report, we relate a unique case of Alice in Wonderland Syndrome in a woman with a right temporo-parietal cavernoma.
Background: Alice in Wonderland Syndrome (AIWS) is a rare constellation of perceptual disturbances marked by distorted body image and metamorphopsia_ illusory changes in the form, size, distance, or color of stationary objects. Although the cause of AIWS is unclear, it has been associated with migraines, epilepsy, Ebstein-Barr virus infection, hallucinogen intoxication, and hypnogogic or hypnopompic states. DESIGN/METHODS: Case report and literature review.
Results: A 34 year-old pregnant woman presented with two weeks of “hearing voices” and “seeing things.” After having a generalized tonic-clonic seizure, she was started on levetiracetam. She had remission of the visual and auditory disturbances. Her EEG, which initially showed right temporal epileptiform activity, improved to showing right temporal slowing without epileptiform activity. Within several days, the patient began to have worsening symptoms: she heard voices of children crying and praying; she saw furniture and houses appearing as boxes, cars appearing as small circles, people having “pink feathery faces” with “long orange hair,” people turning into animals, objects moving forward and backwards, and people shrinking and then magnifying; she felt as if her hands had become “piano keys.” MRI of the brain revealed a right temporo-parietal cavernoma. With further increase of the levetiracetam, she had complete remission of her visual and auditory symptoms.
Conclusions: Previously reported cases of AIWS involve epilepsy, and this patient was recently found to have temporal lobe seizures. However, the perceptual disturbances persisted despite adequate control of her seizure disorder as demonstrated by lack of epileptiform activity on EEG. An association between the right tempo-parietal cavernoma and this patient’s AIWS is reasonable. Alternatively, the symptoms of AIWS could represent a prolonged postictal phenomenon following right temporal lobe seizures. Disclosure: Dr. Kornitzer has nothing to disclose. Dr. Philips has nothing to disclose. Dr. Marks has nothing to disclose. Dr. Lee has nothing to disclose. Dr. Souayah has received personal compensation for activities with Walgreens and Grifols as a consultant and/or speakers bureau participant.