Problems with Perception with Migraine Auras and Alice in Wonderland Syndrome

Problems with perception with migraine auras and Alice in Wonderland syndrome Perception is a daily occurrence involved in taste, touch, smell, and vision. Perception plays a role in all sensory information (Rice University, 2016).Details, for example, how big is this room compared to me, or, that pie smells like my grandmothers, are both sensory inputs. However, the way the information is categorized, and much of its relevance, is based on an individual's perception. Perceptions can mean that a stimulus is perceived to be a certain way, in reference to size, shape, color and relevance, by different individuals based on each individual's personality, experiences, and upbringing (Rice University, 2016). Perception creates taste preferences and makes some sounds beautiful and others unpleasant (Rice University, 2016). Perception of distance, both physical distance, or the requirements to reach a goal, can influence actions and decisions. Perception may not match reality. Illusions are an example of when perception does not match reality (Rice University, 2016).

Illusions are not the only way perception can be altered. Alteration of perception occurs in both migraine auras and is clearly demonstrated at an extreme level in the Alice in Wonderland syndrome. Alteration of perception can be visual or tactile and may affect body size and sense of motion. Auras are most commonly a visual disturbance in perception but may also affect other senses such as taste, hearing, or motor control. The Alice in Wonderland syndrome is thought to be a migraine aura, of sorts. However, the syndrome is not very well understood and has been attributed to several causes. This paper will address perception and two key disturbances found in perception. Migraine is a rather common disorder involving a headache that can last for several days and is recurring (Weatherall,2015). It is though that 1 in 10 people suffer from migraines. (Elrington,2002). Migraines may be accompanied by vomiting, dizziness, sensitivity to light and loss of appetite.(Weatherall,2015). Migraines are thought to have a genetic component. However, events may also drigger the disorder. Migraine auras are thought to be a warning system that precedes impending migraines. Auras are a disturbance in perception. They are usually visual in nature. Migraine auras present days to hours before a migraine and typically last between five to twenty minutes (Elrington,2002). These five to twenty minute disturbances can greatly alter perception by causing some type of illusion or hallucination (Hadjikhani et al 2000). Auras may simply cause spots, gaps, blind spots, and other such changes in the visual field (Weatherall,2015).

Migraine auras are not thought to be the result of problems in the visual field or with the eyes, but with perception. This change in perception is also found in auras that alter the perception of body size. Size perception in migraine auras present as macrosomatognosia which is the perception of body parts being larger, and macrosomatognosia which is the perception of body parts as being smaller (Podoll K & Robinson D, 2000). These change in perception can be localized to one region of the body such as the hands or the head or may involve the whole body. However, this is rare (Podoll K & Robinson D, 2000). Migraine auras are common and can be treated with medication, if the warning is heeded it can help prevent the oncoming migraine. However little is understood regarding what causes them and why and how they change perception. Several explanations have been put forth and longer episodes have been studied using MRI. One such study addressed the mechanisms in the brain that may be involved in auras. Hadjikhani and colleagues studied patients with a history of migraines with auras in the attempt to trigger an aura in an MRI machine. A flickering checkerboard was used to trigger an aura in the first patient while exercise was used to trigger an aura in a second patient (Hadjikhani et al 2000). The study found that auras may be caused by abnormal blood flow in the occipital lobe ( Hadjikhani et al 2000).

Migraine auras help explain the ways in which perception can be altered. They present an opportunity for auras to be properly imaged and studied. While the causes of migraine auras are not agreed upon, it is generally understood that they cause a disturbance in perception. This means that there is nothing wrong with the systems they affect, and sensation and sensory stimuli do not play a role. Migraine auras are a well known example of a disturbance found in perception, but they tend to be small difference such as a gap or spots in the visual field. The Alice in Wonderland syndrome is an example of a dramatic disturbance in perception. The Alice in Wonderland syndrome is a rare perceptual disorder (Mastria et al 2016). Referred to as AIWS, this disorder primarily affects visual perception and somesthetic perception. However, it has been attributed to a variety of perceptual disturbances (Mastria et al 2016). AIWS can also affect body schema and perception of time (Blom,2016). AIWS was discovered in 1955 and has only recently begun to be understood (Blom,2016). AIWS is most prevalent in children. However it can affect adults, especially at sleep onset (Mastria et al 2016). It can be difficult to identify exactly what AIWS is. Originally, it was a term used to describe illusionary disturbances in body size perception (Fine,2018). Vision distortion occurs as either microsia, the perception that an object is smaller than is actually is, or micropsia, the perception that an object is larger than is is in reality (Serhat,2017).

Metamorphopsia is the general term used to describe an assortment of distortion is size, distance, color and shape (Serhat,2017). Unlike migraines, in which disturbances in perception may be relatively minor, AIWS causes larger, more bizarre perceptual distortions (Serhat,2017). Often these disturbances are classified as illusory in nature (Serhat,2017). Visual perceptions such as family members appearing enormous or rooms size shrinking and or the perception that the individual is now too big for the room are common in AIWS. In one such case, a young girl reported disturbances in perception though to be due to AIWS. The girl reported that her cat often appeared to be a tiger, as well as a few other disturbances in the perception of household items (Serhat,2017). Other than the change in perception no other problems were found. However, the girl did have a history of migraines (Serhat,2017). AIWS has been linked to several potential causes. These are epilepsy, Epstein virus, influenza and headaches with migraines, in particular (Mastria et al 2016). Perception iis based on personal experiences, culture and personality (Rice University, 2016). However migraines seem to plays a role in disturbances in perception. This is demonstrated in migraine auras and AIWS. AIWS may be a migraine aura. At the very least, there seems to be a correlation between the two.

AIWS is reported in patients with migraine history. It is believed that both conditions are genetically linked in this way. Migraine auras and AIWS share many symptoms. Perhaps AIWS is just an aura on a larger scale. Both migraine auras and AIWS occur more frequently in females (Mastria et al 2016). These changes to perception can be unsettling, but they are not dangerous. Patients seem to understand that the problem is with perception and not with reality. Many patients have learned that such a disturbance will dissipate in anywhere from ten minutes to half an hour. In the case of children, it may be hard for the child to effectively communicate what is happening, and parents may be concerned. However AIWS usually disappears before adulthood, with full migraines emerging in their place. One of the main problems with AIWS is that it is hard to diagnose since it can have a wide variety of symptoms associated with it. A second problem is differentiating it from migraine auras because they can be similar. Both syndromes may cause changes in perception, but the severity of the disturbance often separates the two. AIWS disturbances are illusionary in nature, while auras are not.

Understanding auras and what an extreme syndrome, such as AIWS looks like may help guide research pertaining to migraines. Auras are an early warning system. So perhaps better understanding the aura could help prevent the migraine if the aura is treated properly. Perception is closely tied to an individual's culture and upbringing and previous knowledge. Individuals may not be conscious of minor changes in perception. However, migraine auras are a noticeable change in perception for many and at the extreme end alice in wonderland syndrome may cause a more disturbing and often larger change to perception. Alice in wonderland syndrome is thought to be most prevalent in people with migraines or migraine history. However it can appear duer to other causes cusch as infections. Better understanding alice in wonderland syndrome and recognizing the many symptoms may help to help further understanding of what is at play in the brain and how to treat severe cases.

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