Functional magnetic resonance imaging of a child with Alice in Wonderland syndrome during an episode of micropsia

BackgroundAlice in Wonderland syndrome is a perceptual disorder involving brief, transient episodes of visual distortions (metamorphopsia) and can occur in conjunction with certain viral infections. We used functional magnetic resonance imaging to examine visual processing in a 12-year-old boy with viral-onset Alice in Wonderland syndrome during an episode of micropsia (reduction in the perceived size of a form).MethodsFunctional magnetic resonance imaging was conducted in response to a passive viewing task (reversing checkerboard) and an active viewing task (line-length decisions in the context of the Ponzo illusion).ResultsIn both tasks, the child with Alice in Wonderland syndrome showed reduced activation in primary and extrastriate visual cortical regions but increased activation in parietal lobe cortical regions as compared with a matched control participant.ConclusionsThe active experience of micropsia in viral-onset Alice in Wonderland syndrome reflects aberrant activity in primary and extrastriate visual cortical regions as well as parietal cortices. The disparate patterns of activity in these regions are discussed in detail.