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AIWS is a fascinating but rare perceptual disorder. It’s not dangerous, but it can be unsettling.
AIWS – It is a rare neurological condition that causes temporary distortions in how a person observes size, distance, body image, and time.
Nomenclature – It is named after the children’s novel, Alice’s Adventures in Wonderland.
Described in –It was formally described in 1955 by British psychiatrist John Todd, who noted patients’ surreal perceptual distortions while they remained aware of reality.
Thus, it is also known as Todd’s Syndrome.
Symptoms
Duration - Episodes are usually brief, lasting from a few minutes to about half an hour.
Objects appear larger or smaller than reality (micropsia/macropsia).
Distorted sense of distance (things seem closer/farther).
Altered body image (hands/head feel shrinking or expanding).
Distorted time perception (time feels fast or slow).
Causes – It is not a disease in itself but a symptom triggered by underlying conditions.
Children - Most often triggered by viral infections (Epstein-Barr virus, influenza, varicella, Lyme disease).
Adults - Commonly linked to migraines (sometimes without headache), temporal lobe epilepsy, certain medications (e.g., dextromethorphan), or brain lesions.
Neurological Basis - Disruptions in the temporo-parietal-occipital junction, which integrates visual, spatial, and sensory information.
Risk – It can occur at any age, but children recovering from viral infections and adults with migraine aura are most at risk.
Diagnosis – There is no definitive test; diagnosis is based on symptom history and ruling out other conditions and supported by MRI/CT scans, EEG and blood tests.
Treatment –There is no specific treatment; it focuses on treating the underlying cause. Infections resolve naturally, migraines need preventive care, epilepsy/lesions require targeted therapy, and reassurance is essential.
