The lesion responsible for the Alice in Wonderland syndrome with visual distortions is located in the right occipital lobe

Abstract Objective Alice in Wonderland syndrome is extremely rare, occurring more often in young than elderly individuals. Symptoms typically include altered body image, size perception, and time perception. The pathophysiology and lesions responsible for Alice in Wonderland syndrome are unknown. In most cases, specific lesions cannot be identified with computed tomography or magnetic resonance imaging. Methods This was a single-center (Nagano Municipal Hospital, Japan), retrospective study that selected consecutive patients who presented with symptoms of Alice in Wonderland syndrome. Results Among the 4724 patients who presented to the emergency room with neurological symptoms, two were enrolled in this study. These patients had isolated cortical venous thrombosis in the right occipital area. Both experienced transient visual symptoms. A literature search indicated that Alice in Wonderland syndrome with visual distortions is associated with right occipital lobe lesions, supporting the present findings. Conclusion Lesions of the right occipital area can be responsible for visual distortions in Alice in Wonderland syndrome.