Abstract
BackgroundAbdominal migraine is a commonly described migraine variant in children and young adults, but associations with Alice in Wonderland syndrome and lilliputian hallucinations are exceptional.Case presentationA 20 years-old male experienced frequent and prolonged attacks of abdominal colic associated with autonomic manifestations started at the age of ten. At the age of 17, he additionally described prolonged attacks (≥ 7 days) of distortions of shape, size or position of objects or subjects. He said "Quite suddenly, objects appear small and distant (teliopsia) or large and close (peliopsia). I feel as I am getting shorter and smaller "shrinking" and also the size of persons are not longer than my index finger (a lilliputian proportion). Sometimes I see the blind in the window or the television getting up and down, or my leg or arm is swinging. I may hear the voices of people quite loud and close or faint and far. Occasionally, I experience attacks of migrainous headache associated with eye redness, flashes of lights and a feeling of giddiness. I am always conscious to the intangible changes in myself and my environment". There is a strong family history of common migraine. Clinical examination, brain-MRI and EEG were normal. Transcranial magnetic stimulation and evoked potentials revealed enhanced cortical excitability in multiple brain regions. Treatment with valproate resulted in marked improvement of all clinical and neurophysiological abnormalities.ConclusionsThe association between the two migraine variants (abdominal migraine and Alice in Wonderland Syndrome) might have clinical, pathophysiological and management implications. I think this is the first description in the literature.
Highlights
Abdominal migraine is a commonly described migraine variant in children and young adults, but associations with Alice in Wonderland syndrome and lilliputian hallucinations are exceptional.Case presentation: A 20 years-old male experienced frequent and prolonged attacks of abdominal colic associated with autonomic manifestations started at the age of ten
Migraine variants (MVs) or migraine equivalents exhibit themselves in forms other than head pain
MVs are less recognized and poorly understood entities of migraine. They are encountered in 3-5% of patients with migraine and usually affect children and young adults [1]
Summary
Migraine variants (MVs) or migraine equivalents exhibit themselves in forms other than head pain. The patient said that abdominal discomfort leaves as suddenly as it comes, offering no clue to when it will return He recognized eating fish or its products as strong triggers for the colic. The pain was severe enough to make him refuse to eat or drink for prolonged periods This resulted in unintentional weight loss (the patient was 45 kilos at presentation), slowed growth and limited life activities and school attendance. At the age of 17, the patient developed abnormal visual phenomena in between the attacks of abdominal colic which lasted longer than a week. There is a strong family history (his father, 2 sisters and one brother) of recurrent hemicranial headaches associated with eye redness, anxiety, nausea and vomiting, that lasted for a period of hours to 3 days and sometimes improved with NSAIDs. The manifestations are suggestive of a common migraine disorder. Informed written consent was obtained from the patient to publish the details of his clinical history, laboratory and imaging data
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