Alice in Wonderland and Ekbom Syndromes in a Bipolar I Manic Episode: A Case Report With Neuroimaging Findings

With recent advances in anatomical and functional brain mapping, Alice in Wonderland syndrome (AIWS), a perceptual distortion disorder, has received increased attention. We report the case of a 67-year-old man with bipolar I disorder (manic episode), AIWS, and delusional parasitosis (Ekbom syndrome). The patient exhibited diverse perceptual distortions across visual, auditory, and tactile modalities. In addition to derealization and depersonalization, he showed a distorted sense of time. Single-photon emission computed tomography (SPECT) revealed a transient but significant decrease in blood flow in the right posterior cingulate region, accompanied by relatively increased blood flow in the bilateral occipital regions during the episode.