‘Alice in Wonderland’ Syndrome and Lilliputian Hallucinations in a Patient with a Substance-Related Disorder

Takaoka, Ken; Takata, Tomoji

doi:10.1159/000029066

Cited by 15 publications

(10 citation statements)

References 5 publications

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“…Takoa ka d escribed a pat ient wh o expe rie nced lilliputian hallucin ation s as a result of ch ronic ingestion of psych oactive co m pone n ts of coug h syr up ( 14). Harper a tt ribut ed lilli pu tia n hallucination s to Amantidin e th e rap y in three of hi s pati ent s (6).…”

Section: Discussionmentioning

confidence: 99%

“…This residu al drug int oxica tion could hav e led to his sta te of psych oti c be hav ior a nd e nsuing halluci nation s. If th e patient wa s not expose d to a hall ucinogen while in prison, he m ay have develop ed a marijuana-induced psych ot ic disorder ind ep endent of his moo d diso rder. T ak oak a not ed th a t, "s ubsta nce-induced psych oti c di sord e rs ca n occ u r within 2 week s of substa nce usc" ( 14). These hallucinations and th e drug us e may be a result of th e pati en t's Bipola r I di sord e r. At th e tim e of th e e pisode he wa s expe rie nc ing an ac ute manic episode.…”

Section: Discussionmentioning

confidence: 99%

“…Visu al hallucin ation s in which peopl e, a nima ls, or objects appear red uced in siz e a re referred to as lilliputian hallucin ation s. H allucin ati on s of th is type have been associa te d with variou s psychi atri c cond it ions (4,5,12,14,15,16), se nile dement ia (16), neurologic di sord ers (8)(9)(10)17), toxi c met abolic sta tes (6,7), head trau ma ( 13), AIDS ( 13), and opht halmologic di sord ers ( I I). This ph en om en on ca n be pleasu ra ble (4) or terrifyin g (2) depending on th e con te nt of th e hallu cination a nd t he contex t in whi ch it is ex pe rie nce d .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Lilliputian Hallucinations and Marijuana Dependence in a Bipolar Patient

Bush¹,

Gupta²

2002

JJP

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Lilliputian Hallucinations and Marijuana Dependence in a Bipolar Patient

Bush¹,

Gupta²

2002

JJP

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“…5,6 Perceptual errors of body schema and objects (kinesthetic illusions or metamorphopsia), of people appearing smaller (micropsia) or bigger (macropsia) than normal, visual hallucinations (Lilliputian hallucinations), and acceleration or deceleration of the passage of time have been attributed to AIW. It may also be associated with vertigo.…”

Section: Sectionmentioning

confidence: 99%

Clinical Reasoning: A case of Wegener granulomatosis complicated by seizures and headaches

Gorman¹,

Hutchinson²,

Tubridy³

2009

Neurology

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A 19-year-old man presented with a 5-day history of vomiting and passing dark urine. He gave a 6-month history of arthralgias and joint swelling, particularly affecting larger joints. He had recurrent epistaxis and recent episcleritis. He was noted to be thin and pale, with conjunctival suffusion and deformity of his nasal bridge. He was normotensive (115/60 mm Hg) and apyrexic (35.5°C). Blood parameters revealed normocytic normochromic anemia and acute renal failure. Renal biopsy showed extensive crescent formation with segmental necrotizing inflammation and fibrin deposition of the glomeruli. cANCA was strongly positive (titer 1280; ELISA PR3ϩ) and he was diagnosed with Wegener granulomatosis. He commenced hemodialysis, steroids, and oral cyclophosphamide, and he was discharged home.One month later, he presented with acute onset of throbbing headaches associated with nausea and photophobia, as well as recurrent generalized seizures necessitating sedation and intensive care unit admission. He was pyrexic (38°C) and hypertensive (165/95 mm Hg). Renal indices were abnormal (urea 29.1mmol/L; creatinine 755 mol/L; potassium 5.4 mmol/L). Clinical examination revealed no focal neurologic deficits.Initial noncontrast brain CT was normal. Brain MRI with gadolinium showed small, ill-defined, nonenhancing high signal areas measuring 5-20 mm in several locations (figure, A).

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“…As already noted by Todd, there are few examples of complete AIWS to be found in the literature. Even today, most reports are concerned with one or several symptoms occurring in association with migraine aura, psychic aura, temporal lobe epilepsy, frontal lobe epilepsy, cerebral lesions, delirium of fever, hypnagogic or hypnopompic states, acute labyrinthine vertigo, a clinical diagnosis of schizophrenia, or a history of psychoactive substance abuse (notably the use of hallucinogens such as dextromethorphan, LSD, and mescaline) [1,5,6,7,8]. A few case reports of AIWS exist in association with depression, bipolar disorder, and obsessive-compulsive disorder [9,10].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Alice in Wonderland Syndrome and Verbal Auditory Hallucinations Using Repetitive Transcranial Magnetic Stimulation: A Case Report with fMRI Findings

et al. 2011

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Background: Alice in Wonderland syndrome (AIWS) is a rare cluster of CNS symptoms characterized by visual distortions (i.e. metamorphopsias), body image distortions, time distortions, and déjà experiences. Verbal auditory hallucinations (VAHs) are the most prevalent type of hallucination in adults with or without a history of psychiatric illness. Here, we report the case of a woman with AIWS, long-lasting VAHs, and various additional perceptual and mood symptoms. Methods: Semi-structured interviews were used to assess symptoms, and functional MRI (fMRI) was employed to localize cerebral activity during self-reported VAHs. Treatment consisted of repetitive transcranial magnetic stimulation (rTMS) at a frequency of 1 Hz at T3P3, overlying Brodmann’s area 40. Results: Activation during VAHs was observed bilaterally in the basal ganglia, the primary auditory cortex, the association auditory cortex, the temporal poles, and the anterior cingulated gyrus. The left and right inferior frontal gyri (Broca’s area and its contralateral homologue) were involved, along with the dorsolateral prefrontal cortex. Interestingly, synchronized activation was observed in the primary visual cortex (areas V1 and V2), and the bilateral dorsal visual cortex. The higher visual association cortex also showed significant, but less prominent, activation. During the second week of rTMS treatment, not only the VAHs, but also the other sensory deceptions/distortions and mood symptoms showed complete remission. The patient remained free of any symptoms during a 4-month follow-up phase. After 8 months, when many of the original symptoms had returned, a second treatment phase with rTMS was again followed by complete remission. Conclusions: This case indicates that VAHs and metamorphopsias in AIWS are associated with synchronized activation in both auditory and visual cortices. It also indicates that local rTMS treatment may have global therapeutic effects, suggesting an effect on multiple brain regions in a distributed network. Although a placebo effect cannot be ruled out, this case warrants further investigation of the effects of rTMS treatment in AIWS.

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‘Alice in Wonderland’ Syndrome and Lilliputian Hallucinations in a Patient with a Substance-Related Disorder

Cited by 15 publications

References 5 publications

Lilliputian Hallucinations and Marijuana Dependence in a Bipolar Patient

Lilliputian Hallucinations and Marijuana Dependence in a Bipolar Patient

Clinical Reasoning: A case of Wegener granulomatosis complicated by seizures and headaches

Treatment of Alice in Wonderland Syndrome and Verbal Auditory Hallucinations Using Repetitive Transcranial Magnetic Stimulation: A Case Report with fMRI Findings

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