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• Vol.64 No.2
• CLINICA NEUROL, 64: 99−104, 2024
• Vol.64 No.2 contents

Case Report

A case of Alice in Wonderland syndrome after Epstein-Barr virus (EBV) encephalitis: a mimicry of focal epileptic seizure

Kyoko Hosokawa, M.D. ^1）2）, Kazuki Oi, M.D., Ph.D. ^1）3）, Takefumi Hitomi, M.D., Ph.D. ^4）, Takahiro Mitsueda, M.D., Ph.D. ^5）, Tomokazu Nakagawa, M.D., Ph.D. ^6）7） and Akio Ikeda, M.D., Ph.D. ^8）

¹⁾Department of Neurology, Kyoto University Graduate School of Medicine
²⁾Present address: Department of Neurology, National Hospital Organization Minami Kyoto Hospital
³⁾Present address: Department of Neurology, National Hospital Organization Nara Medical Center
⁴⁾Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine
⁵⁾Department of Neurology, Osaka City General Hospital
⁶⁾Department of Neurology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital
⁷⁾Present address: Department of Neurology, Takatsuki Red Cross Hospital
⁸⁾Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate School of Medicine

A 30-year-old man who received infliximab for treatment of Crohn's disease developed Epstein-Barr virus (EBV) encephalitis, which responded well to therapy; however, he had left lower visual field loss following treatment. The patient noticed peculiar symptoms 9 months after recovery from encephalitis; objects in his view appeared smaller or larger than their actual size (micropsia/macropsia). Moreover, it appeared that objects outside moved faster or slower than their actual speed of movements and moving objects appeared as a series of many consecutive snap shots. His vision was blurred, and he had visual difficulties and a sensation that his body was floating. These symptoms mainly appeared following fatigue and persisted over approximately 10 years. Based on cerebrospinal fluid analysis, brain MRI, N-isopropyl-p-¹²³I-iodoamphetamine with single photon emission computed tomography, fluorodeoxyglucose positron emission tomography, and electroencephalography, we excluded both recurrent encephalitis and focal epileptic seizures. By taking all symptoms and other evaluation findings into account, the patient most likely suffered from "Alice in Wonderland syndrome" which is primarily associated with cortical dysfunction in the right temporo-parieto-occipital area as the consequence of previous acute EBV encephalitis.
Full Text of this Article in Japanese PDF (4752K)

(CLINICA NEUROL, 64: 99−104, 2024)
key words: Alice in Wonderland syndrome, macropsia, micropsia, abnormality of motion vision, Epstein-Barr virus

(Received: 18-Jul-23)