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

By Marie Savard MD

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.

Before long, Chloe’s visual disturbances lessened and finally disappeared. Her fatigue also lessened. Since she was not highly infectious at that stage, she returned to school. The doctor reminded Chloe that although mono can be caught thorugh contact with saliva and therefore is referred to as the “kissing disease”, it’s acutally not very contagious. However, Chloe’s spleen stayed larger than normal for almost six weeks but she didn’t play contact sports so there was no worry about spleen rupture.

As Chloe told the doctor and her mother, “I’ve always loved Alice’s Adventures in Wonderland but I never thought I’d have the same sensations in real life that she did in the story! Curiouser and curiouser. I’m glad I never had to meet the Red Queen and that I’m now cured. I can fall asleep without feeling that the walls are closing in on me!”

Come back to ThirdAge.com next Thursday when we’ll introduce a new medical riddle!
Marie Savard, M.D., a former Medical Contributor for ABC News and a frequent keynote speaker around the world, is one of the most trusted voices on women’s health, wellness, and patient empowerment. She is the author of four books, including one that made the Wall Street Journal list of the best health books of 2009: “Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About.” Dr. Marie earned a B.S. in Nursing and an M.D. degree at the University of Pennsylvania. She has served as Director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations’ Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women’s Health, health columnist for Woman’s Day magazine, and senior medical consultant to Lifetime Television’s Strong Medicine. Pleas visit DrSavard.com