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Alice in Wonderland Syndrome as a Presenting Manifestation of Creutzfeldt-Jakob Disease

Background: Alice in Wonderland syndrome (AIWS) is a rare neurological disorder characterized by distortions of visual perception (metamorphopsias), the body image, and the experience of time, along with derealization and depersonalization. Some 85% of patients present with perceptual distortions in...

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Autores principales: Naarden, Tirza, ter Meulen, Bastiaan C., van der Weele, Sarah I., Blom, Jan Dirk
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521793/
https://www.ncbi.nlm.nih.gov/pubmed/31143156
http://dx.doi.org/10.3389/fneur.2019.00473
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author Naarden, Tirza
ter Meulen, Bastiaan C.
van der Weele, Sarah I.
Blom, Jan Dirk
author_facet Naarden, Tirza
ter Meulen, Bastiaan C.
van der Weele, Sarah I.
Blom, Jan Dirk
author_sort Naarden, Tirza
collection PubMed
description Background: Alice in Wonderland syndrome (AIWS) is a rare neurological disorder characterized by distortions of visual perception (metamorphopsias), the body image, and the experience of time, along with derealization and depersonalization. Some 85% of patients present with perceptual distortions in a single sensory modality, e.g., only visual or only somesthetic in nature. Moreover, the majority experience only a single type of distortion, e.g., only micropsia or only macropsia. AIWS has many different etiologies, and hence an extensive differential diagnosis. Its amenability to treatment depends on the underlying pathological process, which in children is mostly encephalitis, and in adults, migraine. In the literature, no more than 180 “clinical” cases of AIWS have been described (i.e., cases in need of medical attention). Of them, some 50% showed a favorable prognosis. However, non-clinical cases (i.e., fleeting, transient cases of AIWS for which no professional help is needed) have been described in up to 30% of the general population. This indicates that AIWS is perhaps not as rare as traditionally assumed, and has led some authors to conclude that, prognostically, AIWS is usually harmless. Methods: From our own clinical practice, we describe the first known case of Creutzfeldt-Jakob Disease (CJD, Heidenhain variant) that presented with symptoms of AIWS. Results: In our patient, disease onset was sudden and rapidly progressive, starting with isolated visual symptoms. Symptoms of AIWS comprised akinetopsia, chloropsia, micropsia, macropsia, zoom vision, and time distortions (quick-motion phenomenon and protracted duration). Soon, these were complicated by paraesthesias, gait instability, aphasia, expressive amusia, cognitive decline, and behavioral changes in the form of agitation and emotional lability. The diagnosis of probable sporadic CJD was confirmed with the aid of a head MRI and cerebrospinal fluid (14-3-3 protein). In the absence of any treatment options, our patient was discharged home and died within 2 months after his visual symptoms had begun. Autopsy consent was not obtained. Conclusion: We conclude that AIWS is not always as harmless as sometimes suggested, and that CJD, although extremely rare, must be part of its extensive differential diagnosis, notably in the presence of rapid cognitive decline.
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spelling pubmed-65217932019-05-29 Alice in Wonderland Syndrome as a Presenting Manifestation of Creutzfeldt-Jakob Disease Naarden, Tirza ter Meulen, Bastiaan C. van der Weele, Sarah I. Blom, Jan Dirk Front Neurol Neurology Background: Alice in Wonderland syndrome (AIWS) is a rare neurological disorder characterized by distortions of visual perception (metamorphopsias), the body image, and the experience of time, along with derealization and depersonalization. Some 85% of patients present with perceptual distortions in a single sensory modality, e.g., only visual or only somesthetic in nature. Moreover, the majority experience only a single type of distortion, e.g., only micropsia or only macropsia. AIWS has many different etiologies, and hence an extensive differential diagnosis. Its amenability to treatment depends on the underlying pathological process, which in children is mostly encephalitis, and in adults, migraine. In the literature, no more than 180 “clinical” cases of AIWS have been described (i.e., cases in need of medical attention). Of them, some 50% showed a favorable prognosis. However, non-clinical cases (i.e., fleeting, transient cases of AIWS for which no professional help is needed) have been described in up to 30% of the general population. This indicates that AIWS is perhaps not as rare as traditionally assumed, and has led some authors to conclude that, prognostically, AIWS is usually harmless. Methods: From our own clinical practice, we describe the first known case of Creutzfeldt-Jakob Disease (CJD, Heidenhain variant) that presented with symptoms of AIWS. Results: In our patient, disease onset was sudden and rapidly progressive, starting with isolated visual symptoms. Symptoms of AIWS comprised akinetopsia, chloropsia, micropsia, macropsia, zoom vision, and time distortions (quick-motion phenomenon and protracted duration). Soon, these were complicated by paraesthesias, gait instability, aphasia, expressive amusia, cognitive decline, and behavioral changes in the form of agitation and emotional lability. The diagnosis of probable sporadic CJD was confirmed with the aid of a head MRI and cerebrospinal fluid (14-3-3 protein). In the absence of any treatment options, our patient was discharged home and died within 2 months after his visual symptoms had begun. Autopsy consent was not obtained. Conclusion: We conclude that AIWS is not always as harmless as sometimes suggested, and that CJD, although extremely rare, must be part of its extensive differential diagnosis, notably in the presence of rapid cognitive decline. Frontiers Media S.A. 2019-05-09 /pmc/articles/PMC6521793/ /pubmed/31143156 http://dx.doi.org/10.3389/fneur.2019.00473 Text en Copyright © 2019 Naarden, ter Meulen, van der Weele and Blom. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Naarden, Tirza
ter Meulen, Bastiaan C.
van der Weele, Sarah I.
Blom, Jan Dirk
Alice in Wonderland Syndrome as a Presenting Manifestation of Creutzfeldt-Jakob Disease
title Alice in Wonderland Syndrome as a Presenting Manifestation of Creutzfeldt-Jakob Disease
title_full Alice in Wonderland Syndrome as a Presenting Manifestation of Creutzfeldt-Jakob Disease
title_fullStr Alice in Wonderland Syndrome as a Presenting Manifestation of Creutzfeldt-Jakob Disease
title_full_unstemmed Alice in Wonderland Syndrome as a Presenting Manifestation of Creutzfeldt-Jakob Disease
title_short Alice in Wonderland Syndrome as a Presenting Manifestation of Creutzfeldt-Jakob Disease
title_sort alice in wonderland syndrome as a presenting manifestation of creutzfeldt-jakob disease
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521793/
https://www.ncbi.nlm.nih.gov/pubmed/31143156
http://dx.doi.org/10.3389/fneur.2019.00473
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