Alice in Wonderland syndrome: a lesion mapping study

Area of Science:

• Neurology
• Neuroscience
• Neuroimaging

Background:

• Alice in Wonderland syndrome (AIWS) is a rare neurological disorder causing distorted perceptions of body schema or surrounding space.
• The specific brain regions implicated in AIWS remain unclear.
• Understanding AIWS etiology is crucial for diagnosis and treatment.

Purpose of the Study:

• To identify the specific brain areas affected in patients with Alice in Wonderland syndrome.
• To correlate lesion locations with distinct AIWS symptom presentations.

Main Methods:

• Conducted a systematic literature search for AIWS cases associated with brain lesions.
• Classified AIWS patients into three types based on symptoms: somesthetic (A), visual (B), and mixed (C).
• Employed lesion mapping on a standard brain template to identify overlapping damage sites.

Main Results:

• Maximum lesion overlap was observed in six cases, predominantly in the right occipital lobe (extrastriate cortices, white matter tracts).
• Type B (visual) AIWS patients showed significant overlap in occipital damage sites.
• Types A (somesthetic) and C (mixed) AIWS had more dispersed lesions in the right hemisphere.

Conclusions:

• Visual-type AIWS (Type B) is associated with damage in visual pathways, primarily in the right hemisphere.
• Somesthetic AIWS (Type A) and mixed AIWS (Type C) may involve structural or functional disconnections requiring further investigation.
• This study provides insights into the neuroanatomical correlates of AIWS.