Staccioli Susanna, Mariani Rosanna, Bompard Sarah, Olivini Nicole, Fanfoni Claudia, Mirra Gianluca, Bisozzi Eleonora, Campana Andrea, Lettori Donatella
Neurorehabilitation Unit, Neurological Science and Neurorehabilitation Area, "Bambino Gesù" Children's Hospital - IRCCS, Rome, Italy.
Pediatrics Unit, University Department of Pediatrics, "Bambino Gesù" Children's Hospital - IRCCS, Rome, Italy.
Pediatr Neurol. 2025 Jan;162:28-31. doi: 10.1016/j.pediatrneurol.2024.10.008. Epub 2024 Oct 18.
Alice in Wonderland syndrome (AIWS) is a disorienting neurological condition that affects human perception to the senses of vision, hearing, touch, and sensation and the phenomenon of time. Herein we report two pediatric cases of AIWS temporally related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
An eight-year-old-girl without history of migraine or epilepsy experienced some episodes of visual distortions (micropsia, macropsia, and teleopsia) and misperception of sound, sometimes associated with headache. The onset of symptoms began at the occurrence of fever (38°C), during SARS-CoV-2 infection. Another six-year-old girl, with no history of migraine or epilepsy, experienced short-term episodes of visual (metamorphopsia) and color disturbance (chromatopsia), during an otherwise asymptomatic SARS-CoV-2 infection. In both cases, clinical examination was unremarkable; surface electroencephalography showed normal findings, without any correlation between visual phenomena and cortical activity; and brain magnetic resonance was normal. The patients were given symptomatic treatment, consisting of anti-inflammatory drugs on demand. The frequency of episodes decreased progressively following a negative SARS-CoV-2 test, with full remission in a few weeks. At the moment of hospital admission, none of the patients had completed the two-dose vaccination schedule for SARS-CoV-2.
Based on our clinical experience, we believe SARS-CoV-2 may be responsible for AIWS, in addition to other neurological symptoms more frequently documented in the literature. Pathogenesis is multifactorial and arises from the activation of inflammatory pathways. We therefore suggest also searching for SARS-CoV-2, among other viruses linked with AIWS, in children presenting with visual and/or auditory hallucinations, even as isolated symptoms.
爱丽丝梦游仙境综合征（AIWS）是一种令人迷惑的神经系统疾病，会影响人类对视觉、听觉、触觉、感觉以及时间现象的感知。在此，我们报告两例与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染在时间上相关的小儿AIWS病例。
一名8岁女孩，无偏头痛或癫痫病史，经历了一些视觉扭曲发作（视物显小症、视物显大症和视物显远症）以及声音感知错误，有时还伴有头痛。症状发作始于SARS-CoV-2感染期间发热（38°C）之时。另一名6岁女孩，无偏头痛或癫痫病史，在无症状的SARS-CoV-2感染期间经历了短期的视觉（视物变形症）和颜色障碍（色视症）发作。在这两例病例中，临床检查均无异常；表面脑电图显示正常结果，视觉现象与皮层活动之间无任何关联；脑部磁共振成像也正常。给予患者对症治疗，按需使用抗炎药物。SARS-CoV-2检测呈阴性后，发作频率逐渐降低，几周内完全缓解。入院时，两名患者均未完成SARS-CoV-2两剂疫苗接种程序。
基于我们的临床经验，我们认为SARS-CoV-2可能是AIWS的病因，文献中还更频繁地记载了它导致的其他神经系统症状。发病机制是多因素的，源于炎症途径的激活。因此，我们建议，对于出现视觉和/或听觉幻觉（即使是孤立症状）的儿童，除了其他与AIWS相关的病毒外，也要排查SARS-CoV-2。
