Alice in Wonderland Syndrome in dementia with Lewy bodies: a case report exploring visual cognition dysfunction

Alice in Wonderland Syndrome (AIWS) is characterized by transient distortions in visual perception-alterations in size, shape, and spatial relationships-typically described in migraine or encephalitis. Its occurrence in neurodegenerative conditions, particularly in dementia with Lewy bodies (DLB), remains exceedingly rare.

This article reports a case of a 68-year-old patient with dementia with Lewy bodies (DLB; limbic-early subtype) who presented with typical DLB features alongside a brief episode of misperception-reporting that his bed had "shrunk." Neuroimaging revealed diffuse cortical atrophy with prominent bi-hippocampal and parietal lobe involvement, and hypoperfusion on HMPAO SPECT.

This is the first reported case of AIWS in a patient with DLB. We hypothesize that selective dysfunction of high-level visual networks-particularly in the right extrastriate cortex responsible for the canonical storage of object size-may lead to an agnosia of object size. This case underscores the importance of considering AIWS within the spectrum of visual disturbances in DLB.

These findings provide novel insights into the neurobiology of visual cognition, aligning with Husserl's concept of the "primordial body" (Urleib) and intuition. They suggest that disruptions in the integration of visual sensory inputs and canonical object properties may critically influence the conscious reconstruction of reality.