Objective: To search for reports of children with AIWS associated concussion and synesthesia.  

Alice in Wonderland Syndrome (AIWS) is a rare, disorienting neurologic condition more commonly occurring in children. Children with AIWS experience altered perceptions of their body parts , size and, shape of objects , relative distances, and time similar to the title character in Lewis Carroll’s novel, Alice’s Adventures in Wonderland. This syndrome is most commonly seen in the context of epilepsy, migraines, and Epstein Barr virus-related infections. 

We found  5 patients in our practice meeting criteria for diagnosis of AIWS after concussion. A 14 year-old girl sustained a concussion after striking her right frontal-temporal region of her un-helmeted head against a tree while skiing. She did not lose consciousness, but developed headache in the region of impact. At peak headache Intensity, she said she “saw sounds.” Each sound triggered “kaleidoscope waves of colors " when she snapped her fingers. This phenomenon abated with headache resolution. She had no further similar symptoms thereafter. Reassurances by Dr. Farooq alleviated the child's and parents' anxieties. Literature review revealed mechanisms of AIWS that link our patients’ concussion with acute AIWS. We found no similar cases of AIWS associated with sound induced synesthesia.  Several authors suggested hyper-activation and disruption of normal inhibitory pathways induced by concussion may explain transient synesthesia. 

This patient met criterion for synesthesia, defined as a stimulus of one sense (sound) evoking a response of a different sense (seeing colors). Sound to visual synesthesia has not been previously reported in a child as an acute, self-resolving post-concussive symptom.

Our communication may enhance recognition of AIWS, prevent misdiagnosis, and reduce patient/familial anxiety surrounding disturbing symptomatology of AIWS syndrome.