ABSTRACT
RESUMEN La condición neurológica definida por la aparición de alteraciones en la percepción, usualmente interpretada como fenómenos extraños de metamorfosis y despersonalización, se reconoce como síndrome de Alicia en el país de las maravillas. Se presenta el caso de una paciente femenina de 9 años de edad, con el diagnóstico de síndrome de Alicia en el país de las maravillas secundario a medicación crónica con montelukast. El diagnóstico del síndrome psiquiátrico se realizó teniendo en consideración los antecedentes patológicos personales y el examen físico. El síndrome de Alicia en el país de las maravillas tiene un carácter benigno, sumamente infrecuente, y aunque su etiología no es del todo conocida, su aparición como reacción adversa a medicamentos es una opción que debe ser siempre considerada por el médico actuante (AU).
ABSTRACT The neurological condition defined by the appearance of alterations in perception usually interpreted as strange phenomena of metamorphosis and depersonalization is recognized as Alice in wonderland syndrome. The case of a 9-year-old female patient is presented, with the diagnosis of Alice in Wonderland syndrome secondary to chronic medication with montelukast. The diagnosis of the psychiatric syndrome was made taking into account personal pathological history and physical examination. Alice in Wonderland syndrome has a benign, extremely rare character and although its etiology is not fully known, its appearance, as an adverse reaction to medications, is an option that should always be considered by the acting physician (AU).
Subject(s)
Humans , Male , Female , Child , Drug-Related Side Effects and Adverse Reactions/complications , Alice in Wonderland Syndrome/chemically induced , Asthma/drug therapy , Case Reports , Child , Child Psychiatry/methods , Child Psychiatry/standards , Alice in Wonderland Syndrome/diagnosis , Alice in Wonderland Syndrome/etiology , Alice in Wonderland Syndrome/pathology , Alice in Wonderland Syndrome/psychologyABSTRACT
INTRODUÇÃO: O síndrome de Alice no País das Maravilhas (SAPM) é uma entidade rara que pode ocorre no contexto de várias condições clínicas, sendo a infeção por vírus Epstein-barr (EBV) a mais comum nas causas infeciosas. Apresenta-se um caso de SAPM associado a infeção a EBV alertando para a necessidade de investigação etiológica destes casos. RELATO DE CASO: Criança de 8 anos, com síndrome de Asperger que, no contexto de amigdalite aguda e febre, surgiu com episódios paroxísticos de alguns minutos de metamorfopsias (macro e micropsia), distorção da perceção das vozes e sensação de medo. A ressonância magnética e o eletroencefalograma foram normais, e o exame citoquímico do líquor foi normal mas a polimerase chain reaction (PCR) foi positiva para vírus EBV. As serologias para EBV, repetidas 3 e 10 semanas após a avaliação inicial, confirmaram uma reativação da infeção por este agente. O doente ficou assintomático após 2 semanas e não houve recidivas. CONCLUSÕES: A investigação de metamorfopsias ou síndrome de SAPM é mandatória pois podem indiciar patologia grave, nomeadamente lesão cerebral ou epilepsia focal. Embora a doença seja rara a etiologia infecciosa deve ser excluída mesmo em doentes com perturbação prévia do comportamento.
INTRODUCTION: Alice in wonderland syndrome (AWS) is a rare condition which may occur as a sign of multiple conditions, with the most frequent infectious etiology being Epstein-barr virus (EBV) infection. We present a case of an AWS caused by EBV infection to alert for the need to investigate these cases. CASE REPORT: 8-year-old boy with Asperger syndrome who developed, in the context of tonsillitis and fever, brief paroxystic episodes of metamorfopsias (macro and micropsia), with voice perception distortion and fear. Physical exam was otherwise normal. Brian magnetic resonance and electroencephalogram were normal, liquor cytochemical exam was normal but Epstein-barr virus (EBV) polimerase chain reaction was positive. EBV blood serologies, repeated 3 and 10 weeks after the initial evaluation, confirmed the reactivation of this agent's infection. Symptoms succumbed 2 weeks after its beginning, with no relapses. CONCLUSIONS: Metamorfopsias or AWS impose etiological investigation because they may occur due to severe disease, namely cerebral lesion or focal epilepsy. Although it is a rare disease, infectious causes should be excluded, even in patients with previous disturbed behavior.
Subject(s)
Humans , Male , Child , Epstein-Barr Virus Infections/complications , Epstein-Barr Virus Infections/diagnosis , Alice in Wonderland Syndrome/diagnosis , Alice in Wonderland Syndrome/etiology , Diagnosis, Differential , Alice in Wonderland Syndrome/psychologyABSTRACT
La migraña con aura en pacientes pediátricos es reportada con frecuencia; el aura típica sin migraña, en raras ocasiones, y el aura persistente asociada al denominado síndrome de Alicia en el País de las Maravillas, excepcionalmente. El objetivo de este reporte es presentar un caso clínico correspondiente a la última variedad mencionada. Se trata de una paciente de 6 años de edad, quien tuvo, al menos, dos episodios con estas características antes de presentar un cuadro clínico completo de aura y, consecutivamente, cefalea con más frecuencia. Los estudios complementarios practicados de manera sistemática a la paciente fueron normales, con mejoría clínica con el tratamiento convencional. Se debe sospechar el síndrome en todo paciente que se presente con las características descritas a fin de aproximarse al diagnóstico de aura sin migraña, descartar patologías orgánicas o de otra naturaleza e instaurar la terapéutica adecuada.
Migraine with aura in children is often reported, typical aura without headache is reported sometimes, but persistent aura and Alice in Wonderland syndrome is exceptionally reported. We present a case corresponding to the last one mentioned in a 6-year-old patient who had at least two episodes with the typical characteristics of aura without migraine before developing more frequently the complete clinical picture of aura and subsequently headache. The complementary studies systematically done to the patient were normal and she improved with conventional therapy. It is important to emphasize that the syndrome should be suspected in any patient who presents the described manifestations in order to approach to the diagnosis of aura without migraine, to discard either organic pathology or another cause and to indicate adequate therapeutic measures.
Subject(s)
Humans , Female , Child , Child , Migraine with Aura , Alice in Wonderland SyndromeABSTRACT
Abstract The Alice in Wonderland syndrome is a rare clinical neurological condition, defined by the presence of perception disorders usually interpreted by the affected patient as rare metamorphosing and depersonalization phenomena. Due to its extremely rare occurrence and its surreal and sometimes psychedelic character, the syndrome has been associated with the phenomena experienced by Alice, the character in the classic and world-famous story by Lewis Carroll.
Resumen El Síndrome de Alicia en el País de las Maravillas es una condición clínica neurológica de rara aparición, definida por la aparición de alteraciones en la percepción usualmente interpretadas por el paciente que las experimenta, como fenómenos extraños de metamorfosis y despersonalización. Por su naturaleza altamente inusual y su carácter surreal e incluso en ocasiones psicodélico, se ha relacionado al cuadro con los fenómenos experimentados por el personaje de Alicia, en la clásica y mundialmente reconocida historia de Lewis Carroll.
Subject(s)
HumansABSTRACT
Alice in wonderland syndrome (AWS) is a paroxysmal disorder with distorted body image, including altered perceptions of size, mass, or shape. In fact, altered body image is the classic symptom of AWS. However, young children and adolescents younger than 15 years with AWS usually show visual symptoms, including micropsia or teleopsia. The most common visual symptom with AWS is micropsia. There are several theories of the etiology of AWS, the most popular of which is migraine. The second most frequently mentioned etiologic theory of AWS is that it is infection-induced. Finally, abnormal brain electrical activity, such as epilepsy, is another possible cause of AWS. We herein report a case of 9-year-old boy who was admitted with visual disturbances characterized by microteleopsia and pelopsia. He denied headache, but his mother had a history of migraine. His general physical examination was unremarkable. Brain magnetic resonance imaging did not show any abnormal findings, but an electroencephalogram showed abnormal discharges. The patient was prescribed an antiepileptic drug, which improved his symptoms.
Subject(s)
Adolescent , Child , Humans , Male , Alice in Wonderland Syndrome , Body Image , Brain , Electroencephalography , Epilepsy , Headache , Magnetic Resonance Imaging , Migraine Disorders , Mothers , Physical Examination , Vision DisordersABSTRACT
Alice's Adventures in Wonderland by Lewis Carroll, pseudonym of Charles Lutwidge Dodgson, is a psychedelic dream tale apparently made for amusement. But, many speculations may be raised about its characters and phenomena created by a devout, learned and imaginative mathematician/logistician. Some issues based on the Cheshire cat due to its vanishing apparitions and its clever arguments are considered. The interpretation of the visual perception may include the "binding problem" issue. Regarding the cat's thought about inquiry, fundamental for researchers, this represents similar reasoning to that of Claude Bernard. Secondarily, some neurological and psychopathological speculations are also focused.
As aventuras de Alice no País das Maravilhas por Lewis Carroll, pseudônimo de Charles Lutwidge Dodgson, é um conto de sonho psicodélico, aparentemente feito para diversão. Mas muitas especulações podem ser levantadas sobre seus personagens e fenômenos criados por um devoto, erudito e criativo matemático/especialista em logística. São feitas algumas considerações sobre o gato de Cheshire devido suas aparições evanescentes e seus argumentos inteligentes. A interpretação sobre a percepção visual pode incluir a questão do "binding problem". Em relação ao pensamento do gato sobre a investigação, fundamental para os pesquisadores, isso representa raciocínio similar ao de Claude Bernard. Secundariamente, algumas especulações neurológicas e psicopatológicas também são apresentadas.
Subject(s)
Humans , Perceptual Distortion , Neuropsychiatry , Alice in Wonderland Syndrome/diagnosis , Alice in Wonderland Syndrome/history , Literature, Modern/history , Psychopathology , Migraine DisordersABSTRACT
Aims: Alice-in-Wonderland syndrome (AIWS) is a rare neuropsychological syndrome that includes paroxysmal distortion of the body schema, depersonalization, derealization, visual hallucinations, distorted sense of time, and deja vu and jamais vu experiences. Alice-in-Wonderland syndrome may be an equivalent of a migraine attack. The objective of this study was to evaluate the clinical particulars of Alice-in-Wonderland syndrome in patients suffering from migraine. Place and Duration of Study: University Headache Clinic between June 2012 and November 2015. Methodology: The study sample involved 14 subjects with migraine as defined in the ICHD-III-beta and AIWS (1 male and 13 females) with a mean age of 22.9±12.1 years. 13 patients had migraine with aura, and one subject had migraine without aura. All study subjects were somatically and psychiatric healthy. A specially designed and validated questionnaire was being used to assess symptoms in patients with AIWS. Results: Alice-in-Wonderland syndrome was characteristically being developed in children and adolescents as part of a migraine aura, combined with a typical impairment of visual perception, or between attacks, and also had episodes of visual hallucinations. Older patients were characterized by only interictal, short (lasting a few seconds) phenomena, which was most commonly teleopsia. Conclusion: The reported study indicates that Alice-in-Wonderland syndrome is a heterogeneous condition varying with different age subgroups among patients with migraine.
ABSTRACT
We describe a patient who suffered an infarct of the right medial temporal lobe, and developed visual illusions for body images, referred to as Alice in wonderland syndrome (AIWS). Although, these phenomena are usually seen in settings of migraine with aura or epilepsy, an association with strokes has not previously been described. The occurrence of AIWS in our patient, following an infarct of the right medial temporal lobe, provides support for this symptom having a biological and anatomical substrate.