Lesions Causing Alice in Wonderland Syndrome Map to a Common Brain Network Linking Body and Size Perception

Area of Science:

• Neuroscience
• Neurology
• Perceptual Psychology

Background:

• Alice in Wonderland syndrome (AIWS) causes significant alterations in body and environmental perception.
• The neuroanatomical basis of AIWS has been unclear due to varied lesion locations.
• Understanding AIWS's neural underpinnings is crucial for treating perceptual disorders.

Purpose of the Study:

• To investigate if brain lesions causing AIWS converge on a common distributed neural network.
• To identify the specific brain regions and connectivity patterns associated with AIWS.
• To differentiate the AIWS network from those of other neuropsychiatric conditions.

Main Methods:

• A retrospective case-control study analyzed 37 cases of lesion-induced AIWS from literature.
• Resting-state functional connectome data from 1,000 healthy individuals were used to map lesion connectivity.
• AIWS lesion connectivity was compared against 1,073 control lesions and functional neuroimaging in non-lesional AIWS cases.

Main Results:

• AIWS-associated lesions were found in diverse brain areas with minimal overlap.
• Over 85% of lesions shared connectivity with the right extrastriate body area and inferior parietal cortex.
• This connectivity pattern was unique to AIWS compared to other disorders and consistent across lesional and non-lesional cases.

Conclusions:

• AIWS perceptual distortions are linked to a common brain network involved in body representation and size-scale processing.
• These findings elucidate the neuroanatomy of higher-order perception.
• The study may guide future therapeutic interventions for perceptual disturbances.