Transient Episode of Alice in Wonderland Syndrome After Ventriculoatrial Shunt Revision

Visual misperceptions as a result of neurosurgical disorders are well documented. Alice in Wonderland syndrome (AWS) typically is reported in neurologic and psychiatric disorders. We present a patient who developed symptoms of AWS postoperatively. A 48-year-old man presented in shunt failure, attributed to a proximal catheter occlusion. Operative revision with replacement of the proximal catheter was performed without incident. Postoperatively, he complained of visual disturbances, including the perception that people had small heads on full-sized bodies. Symptoms resolved postoperatively. The patient’s symptoms were diagnosed as a transient episode of AWS. This was attributed to manipulation of the parieto-occipital cortex during the revision. The local inflammatory response from manipulation of that area is thought to have caused our patient’s symptoms. Visual disturbances caused by lesions along the optic radiations are common findings for neurosurgery patients, although AWS after surgical intervention has not been reported previously.