Micropsia and Polyopia Following Multi-Focal Infarction: A Case Report

Individuals with Alice in Wonderland syndrome can present with a wide variety of visual symptoms. Most commonly, visual disturbances in size perception such as micropsia or macropsia are observed. However, rarer disturbances such as the visual perception of multiple images, termed polyopia, as well as kinetopsia, a visual illusion in which stationary objects are perceived as moving, have also been described. Previous neuroimaging of different individuals with Alice in Wonderland syndrome has shown the involvement of topographically separate brain regions. Here, we describe an individual who sequentially developed both micropsia and concurrent polyopia with kinetopsia following multi-focal infarction from underlying endocarditis. We show and describe his neuroimaging findings, as well as contextualize this with recent work showing how Alice in Wonderland syndrome may be subserved by a common distributed brain network.