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Solve the Medical Riddle: Her Daughter Feels as Though the Room is Shrinking, Fourth Week

Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

The first week of this riddle, the patient reported her symptoms and the doctor proceeded with the examination. This was step #1, S, of the classic the classic S-O-A-P notes as follows:
S=Symptoms or Chief Complaint
O=Objective Findings
A=Assessment or Analysis
P=Treatment Plan or Recommendations

The second week, the doctor moved on to O and A=Assessment or Analysis to continue to look for clues to the medical riddle. Last week, we let you know what some people had suggested as possible diagnoses. This week, the doctor will move on to P to reveal the actual diagnosis. Then we’ll begin a new riddle for the following month!

The Doctor Reveals the Diagnosis

Betty F. and her daughter were joking about Alice in Wonderland but Alice in Wonderland Syndrome (AIWS) is in fact the correct diagnosis for Chloe’s problem! The condition, which is named for Lewis Carroll’s iconic fantasy novel, was first pinpointed in 1955 by a psychiatrist named John Todd. There has been speculation that Carroll suffered from severe migraines and had AIWS as a result. What’s interesting is that mononucleosis associated AIWS is more common in children younger than 18, which was the case for Betty’s daughter.

Cathy R. was also on the right track. AIWS is like an aura of migraine without the headache and studies have shown similar mechanisms for AIWS and migraines, such as reduced blood perfusion to areas of the brain during an attack that is like the vasoconstrictive phase of migraine.

A recent review of all the English language reported cases found that it is best to divide symptoms into one of three types:

Type A or somesthetic This is the classic AIWS in which the person feels his or her own body is distorted in size. This type was the rarest overall.

Type B, visual The person perceives that his or her environment is shrinking or expanding. The episodes are often triggered by mini blinds and by falling asleep. This type is most typical for patients with infectious mononucleosis.

Type C, combination of both A and B This type is most typical for patients with migraines.

Some researchers say that Type B with only visual symptoms isn’t really AIWS because Alice felt her body shrink and expand rather than the environment but other experts say this is a matter of semantics.

The doctor reassured Chloe that her visual symptoms would eventually go away. No medications were necessary and none were prescribed. The doctor recommended that Chloe should stay home from school for a few weeks until the symptoms of the Epstein Barr virus, the cause of mononucleosis, subsided.

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