Alice in Wonderland syndrome

How it works

The eyes work normally. The distortion happens later, where the brain works out how big things are and how far away¹. The main forms have names. Micropsia: things look too small. Macropsia: too big. Teleopsia: too far away. Pelopsia: too close¹². Body parts can seem to swell or shrink. Time can feel too fast or too slow. Many episodes come with a sense of unreality¹. An episode usually lasts from a few minutes to an hour¹.

In children the most common trigger is infection, especially Epstein-Barr virus, the cause of glandular fever¹⁴. Influenza and chickenpox have also been reported as triggers¹. Fever alone can set it off. In adults the usual trigger is migraine, and the episode can come before, during, or instead of the headache¹⁵. Rarer causes include epilepsy and some drugs¹.

The brain region most often implicated is the junction of the temporal, parietal, and occipital lobes, where the brain combines what you see with what your body feels¹. One interpretation uses the brain’s two visual streams. The ventral stream, in the temporal lobe, handles what an object is and its relative size. The dorsal stream, in the parietal lobe, handles absolute position and movement³. If fever disturbs one stream more than the other, you could see a tower that looks enormous and yet moves through the room like an ordinary object. This is an interpretation, not a proven mechanism.

One of the few brain scans taken during an episode fits the idea. In 2010, a 12-year-old with micropsia after scarlet fever showed reduced activity in the visual cortex and excess activity in the right superior parietal cortex⁷. In 2024, a study of 37 cases caused by brain lesions found that at least 85% of the lesions were connected to one network⁸. It links the right extrastriate body area, which responds to images of body parts, to the inferior parietal cortex, which judges size and scale⁸. The lesions themselves sit in different places and overlap very little⁸.

How common it is

A review of 169 published cases found that 132 (about 78%) were 18 or younger, with an average age of 9⁹. Clinical cases undercount. A survey of 3,224 Japanese adolescents found size distortion in 6.5% of boys and 7.3% of girls¹. Up to 30% of adolescents report at least one symptom⁹. Among people with migraine, the rate may be around 15%⁹. Doctors think it is underdiagnosed because children rarely mention it.

Is it a problem?

Usually not. In children it goes with an infection and usually stops within days to months¹. Nothing is damaged. Telling a child what it is helps, because the experience is frightening.

See a doctor if the episodes:

• keep coming back,
• last more than an hour,
• happen without a fever or migraine,
• come with a severe headache, seizure, weakness, confusion, or loss of vision.

Those need to be checked.

History and culture

The British psychiatrist John Todd described and named the syndrome in 1955¹. Lewis Carroll’s diaries record severe headaches with visual fortification patterns, which are classic migraine aura⁶. Todd suggested that Carroll drew Alice’s growing and shrinking from his own experience¹.