063 ‘Have I gone MAD?’: a case of alice in wonderland syndrome

Case ReportIntroductionAlice in Wonderland Syndrome (AIWS) is a rare neurological disorder that is characterised by unusual distortions to perception. The aetiology of AIWS is unclear, though it has been reported in a number of neurological conditions including infection (esp. EBV), CNS lesions, migraines and as a side effect to medications.This report outlines the case of a 72 year old gentleman who presented to hospital due to visual changes which he described as dysmetropsia (objects appeared distorted - thinner) and episodic chromatopsia. His chromatopsia was described as his entire visual field coloured with an orange hue, though this colour changed throughout the course of his admission. Movements appeared to occur in slow motion and movements of humans had a robotic appearance. Neurological examination was otherwise normal.These symptoms resolved after 2 days, and on subsequent examination his neurological and ophthalmological examinations were unremarkable.ResultsMRI brain revealed a right occipito-temporal T2 hyperintense lesion, initially interpreted as a subacute ischaemic infarct. Repeat MRI with contrast revealed a stable appearance of the lesion with areas of subtle contrast enhancement. PET scan showed reduced metabolic activity within the lesion with reduced FDG accumulation.Biopsy of the lesion identified features of a diffuse astrocytoma.ConclusionsAIWS is a poorly recognised syndrome. Symptoms are not typical for an ischaemic event and alternative diagnosis should be investigated as an explanation for the cause of visual distortions.