Alice in Wonderland Syndrome and Covid-19: A Report of Three Cases
Ana Moura Figueiredo1,2, Laura Correia1,3, Joana Afonso Ribeiro1, Cristina Pereira1 and Filipe Palavra1,4,5*
1 Center for Child Development – Neuropediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
2 Pediatrics Department, Centro Hospitalar do Médio Tejo, Torres Novas, Portugal.
3 Pediatrics Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal.
4 Laboratory of Pharmacology and Experimental Therapeutics, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
5 Clinical Academic Center of Coimbra, Coimbra, Portugal.
*Corresponding Author: Filipe Palavra, Center for Child Development – Neuropediatrics Unit, Hospital Pediátrico, Avenida Afonso Romão, 3000-602 Coimbra, Portugal, ORCID-ID: 0000-0002-2165-130X.
DOI: https://doi.org/10.58624/SVOANE.2023.04.087
Received: March 20, 2023 Published: April 05, 2023
Abstract
Introduction: “Alice In Wonderland Syndrome” (AIWS) is characterized by episodes of distorted perceptions or temporal/spatial changes. The pathophysiological mechanism is not well defined. However, some authors argue that it is a rare perceptive disturbance, which affects mainly associative sensorial cortex integration mechanisms, involved in internal-external relationship development. It was initially described in migraine and/or epilepsy patients. Infections are considered the main cause of AIWS in children, and it can occur before, during or after the contact with the microorganism. COVID-19 is the disease caused by the SARS-CoV-2 virus, which can be linked with neurological manifestations.
Clinical case reports: Three children, between 6 and 11 years of age, previously healthy and without personal or familiar history of migraine and/or epilepsy, were observed in Neuropediatrics consultations because of visual changes, described as corresponding to macropsia, micropsia, teleopsia and pelopsia. In two of the cases, symptoms began during SARS-CoV-2 infection and, in the other one, a week after the disease. Every episode lasted a few minutes and resolved spontaneously in a few days.
Discussion: No complementary exams are needed to diagnose AIWS. Nevertheless, when paroxysmic visual changes are present, other aetiologies frequently need to be excluded. Generally, episodes are self-limited, and symptoms completely resolve, with a long-term good prognosis. Until this moment, AIWS has not been linked to COVID-19. However, in this case reports, SARS-CoV-2 was the only identified trigger. Similarly to other viruses, like EBV or H1N1, cerebral hypoperfusion by hypoxemia and/or by pro-inflammatory cytokines action in response to SARS-CoV-2 are possible underlying pathophysiological mechanisms.
Keywords: Alice in Wonderland Syndrome; Children; COVID-19
Citation: Figueiredo AM, Correia L, Ribeiro JA, Pereira C, Palavra F. Alice in Wonderland Syndrome and Covid-19: A Report of Three Cases. SVOA Neurology 2023, 4:2, 29-32.
