What is Alice in Wonderland syndrome?

Down the rabbit hole for this one!

Also in this week's column:

• Can you really see the Great Wall of China from the Moon?
• Are secretive people more or less healthy?
• How far can the naked eye see?

What is Alice in Wonderland syndrome?

Asked by Sheena Roberts of Dublin, Ireland

Alice in Wonderland syndrome (AWS) is a neurological condition where a person experiences a complete distortion of perceptual reality. They experience acute visual disorders relating to shape, size, colour, and the relationship of objects. They are confused by everything they perceive.

In a room, a door knob can appear to be the size of the door itself. The flat floor can appear to slope upwards and then drop off entirely. The walls can seem to close in one moment and move outwards to the horizon the next. Chairs and tables can seem to float to the ceiling and spin like tops in mid-air. Visual perception is so altered that one can lose their grasp of all reality.

Just as the little girl in the Lewis Carroll classic Alice's Adventures in Wonderland (1865), one doesn’t know what is and what isn’t.

AWS was named by Dr C W. Lippmann in a 1952 article in the Journal of Mental Diseases entitled "Certain Hallucinations Peculiar to Migraine".

But AWS was most famously described by Dr J Todd in a 1955 article in the Canadian Medical Association Journal.

We now know that AWS can occur as a symptom of migraine, epilepsy, acute fever (febrile states), schizophrenia, Epstein-Barr viral infection, infectious mononucleosis (glandular fever), or as a result of ingesting hallucinogenic drugs such as LSD and marijuana.

Previously, neurological manifestations of AWS were usually ascribed to damage to the brain's parietal lobe (located at the top and towards the rear of the brain).

Whatever the cause, the distortions can recur several times a day and can last from a few minutes to a few weeks. Understandably, the sufferer can become alarmed, frightened, and even panic-stricken. Fortunately, treatment is straight-forward and with an excellent prognosis. This is according to Dr Randolph Evans, a clinician in Houston, Texas and Dr Loren Rolak, a clinician at the Marshfield Clinic in Marshfield, Wisconsin.

It is unknown how many people suffer from AWS. Drs Evans and Rolak report on two cases of AWS: A 31-year-old woman with a 10 year history of mild migraines and a 27-year-old woman who has experienced AWS symptoms about twice a week since age 12. They note with subtle humour in the June 2004 Headache, "rare migraineurs have strange symptoms where the diagnosis may be lurking just down the rabbit hole".

With AWS, as Alice might say, things are indeed "curiouser and couriouser".

Stephen Juan, Ph.D. is an anthropologist at the University of Sydney. Email your Odd Body questions to [e-mail]