PT  - JOURNAL ARTICLE
AU  - Shin C. Beh
AU  - Shamin Masrour
AU  - Stacy V. Smith
AU  - Deborah I. Friedman
TI  - Clinical characteristics of Alice in Wonderland syndrome in a cohort with vestibular migraine
AID  - 10.1212/CPJ.0000000000000518
DP  - 2018 Oct 01
TA  - Neurology: Clinical Practice
PG  - 389--396
VI  - 8
IP  - 5
4099  - http://cp.neurology.org/content/8/5/389.short
4100  - http://cp.neurology.org/content/8/5/389.full
AB  - Background Alice in Wonderland syndrome (AIWS) is a rare sensory perception disorder, most often caused by migraine in adults. We aimed to characterize the clinical characteristics of AIWS in a cohort of vestibular migraine (VM) patients.Methods Retrospective chart review of patients diagnosed with VM seen between August 2014 and January 2018.Results Seventeen patients were identified (10 women) with a median age at onset of 45 years (range 15–61 years), and median age at presentation of 49 years (range 17–63 years). Eighty-two percent reported 1 AIWS symptom, 12% reported 3 symptoms, and 6% described 2 symptoms. The most common symptom was visual distortions (47%), followed by extrapersonal misperceptions (41%) and somesthetic distortions (29%). Most AIWS occurred during VM episodes (77%). Eleven patients were seen in follow-up; 10 described complete or partial resolution of both AIWS and VM with migraine preventive therapy, while 1 experienced complete resolution of VM but continued to have AIWS. Neuro-otologic abnormalities improved in 2 patients.Conclusions This study characterizes the clinical features of AIWS in patients with VM. We observed several rare and highly unusual AIWS misperceptions (frosted-glass vision, underwater vision, dolly zoom effect, sensation of the brain coming out of the head, closed-eye visual hallucinations, and headlight glare–induced marco/microsomatognosia), and resolution or improvement in AIWS and VM with migraine preventive treatment.