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Lewis Carroll's classic Alice in Wonderland describes Alice's fantastical experiences so similarly to the actual phenomenology of the eponymous syndrome, that it has been previously suggested that Carroll himself experienced it. The syndrome is mostly associated with migrainous aura, and naturally, Carroll was postmortemly "diagnosed" as a migraineur. However, when considering his unique personality profile, it appears that he might have had temporal lobe epilepsy.

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BACKGROUND/OBJECTIVE: Gender inequality has been a long-standing issue throughout history, with limited progress despite the rise of women in the workforce. Historically, women were deemed inferior to men, including within the medical profession, due to perceived bodily differences. METHOD: This perception was reinforced in religious texts, depicting women as bearing the burden of the first woman's transgressions. Such attitudes also influenced the treatment of women's health, with menstruation viewed as a natural source of suffering. Nevertheless, a thorough examination of medical history unveils a deep-rooted bias against women. RESULTS: This antiquated and discriminatory notion lacks any foundation in scientific truth. Indeed, an examination of the contributions made by female physicians reveals that they deliver equivalent levels of care, attentiveness, preventive measures, and therapeutic efficacy as their male counterparts. The narratives of female trailblazers in the medical field, like Alice Rosenstein, the first female neurosurgeon in Germany, provide compelling evidence of this phenomenon. CONCLUSIONS: This paper delves into her professional journey and the significant influence she has had on the field of neurosurgery.

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The article aims to explore the challenges involved in diagnosing and managing Alice in Wonderland Syndrome (AIWS) in pediatric cases, focusing on an eight-year-old female with perceptual distortions affecting vision, hearing, and time perception. AIWS, a rare neurological phenomenon, manifests as distortions in the perception of the body and external stimuli. The lack of established diagnostic criteria, particularly in the pediatric population, complicates accurate identification. The presented case illustrates visual anomalies, auditory abnormalities, and tachysensia, emphasizing the multisensory nature of AIWS. The temporal association with underlying causes, such as migraines and viral infections, highlights the need for a comprehensive evaluation. The Acharya Vinoba Bhave Rural Hospital management approach involves a systematic assessment, identification of underlying chronic conditions, and targeted treatment. Migraine prophylaxis, utilizing prescription drugs and a low-tyramine diet, plays a central role. The limited use of antipsychotics underscores the neurological origin of AIWS. The article contributes valuable insights into pediatric AIWS, advocating for further research and awareness. The article also aims to highlight the lack of established diagnostic criteria for AIWS, particularly in the pediatric population, and to present a systematic management approach based on a specific case study. The multidisciplinary collaboration, regular follow-ups, and patient education constitute a comprehensive approach to enhance understanding and alleviate symptoms in AIWS cases.

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PURPOSE: To review the vestibular, aural, and perceptual symptoms of vestibular migraine (VM) that may present alongside vertigo. RECENT FINDINGS: Increased research attention to the wide spectrum of symptoms presenting in VM patients has improved understanding of this disorder, with recent identification of five different VM phenotypes. Research into the clinical overlap between VM and other chronic vestibular syndromes such as persistent postural-perceptual dizziness and mal-de-debarquement syndrome reveals a range of vestibular symptoms and hints at pathophysiological connections between migraine and vestibular dysfunction. Studies of migraine treatment for hearing loss suggest patients presenting with aural symptoms may have an underlying diagnosis of migraine and deserve a trial of migraine preventives. Research into the neurologic basis of the perceptual disorder Alice in Wonderland syndrome has revealed brain areas that are likely involved and may help explain its prevalence in VM patients. VM is a sensory processing disorder that presents with more than just vertigo. Understanding the range of potential symptoms improves diagnosis and treatment for migraine patients whose diagnosis may be missed when only the symptoms identified in the diagnostic criteria are considered.

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Alice Dunbar-Nelson is mostly remembered as a poet, activist, and ex-wife of Paul Laurence Dunbar. Her volume The Goodness of St. Rocque and Other Stories (1899) has been largely overshadowed as a result. Yet, the collection contains a portfolio of heroines analogous and contemporaneous to the famed New Woman figure of the fin de siècle. In this article, I consider Dunbar-Nelson's heroines in light of their New Woman-esque agency and autonomy as they find remedies and power in objects and materials steeped in New Orleans's cultural heritage. Ceded neither social nor political self-governance nor domestic comfort, this article reads these transcendental, metaphysical objects as sources of self-care. With close analysis of "The Goodness of St. Rocque," "Tony's Wife," and "Little Miss Sophie," I argue that Dunbar-Nelson's protagonists exert influence over their lives, specifically in the negotiation of romantic relationships, through voodoo charms, Catholic candles, tarot cards, sewing machines, and knitting needles. Covering courtship, break-ups, and unhappy marriages, I demonstrate the ways in which these empowering spiritual objects respond to health concerns, including malnutrition and domestic violence, in turn, situating them as alternatives to patriarchal and historically racist medical institutions. Valorizing the cultural milieu of New Orleans and the customs of the Caribbean and European heritage, and thereby conveying Dunbar-Nelson's resistance to white and male supremacist ideologies in late-nineteenth-century Southern America, the article ultimately assesses the parallels with (predominantly white) New Woman fiction, through shared themes of fraught heterosexual dynamics and women's declining health.

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El síndrome de Alicia en el País de las Maravillas es un conjunto de trastornos complejos de la percepción visual con múltiples etiologías, siendo las infecciones las más frecuentes en Pediatría. Es un cuadro poco frecuente, pero es importante conocerlo por su carácter generalmente autolimitado. Presentamos el caso de un niño de 11 años que, a las 48 horas de infección por SARS-CoV-2, inició distorsión visual de la forma corporal, micropsias y macropsias. Se descartaron otras causas orgánicas, manteniéndose actitud expectante dada su evolución benigna. Se destaca la aparición de este síndrome en contexto clínico de infección por SARS-CoV-2, no habiendo sido descrita hasta ahora su asociación en la literatura. (AU)

The Alice in Wonderland syndrome is defined by the presence of visual perception disorders with several etiologies, being infectious the most frequent in pediatrics. It is a rare clinical condition, but it is important to recognize it because of the generally self-limited nature. We present an 11 years old child who presented visual body distortions, micropsia and macropsia 48 after SARS-CoV-2 infection. Other organic causes were discarded, maintaining an expectant treatment because of its benign evolution. It is noteworthy that this syndrome associated with SARS-CoV-2 infection has not yet been published. (AU)

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Objective Automated scoring of respiratory events could allow a swifter obstructive sleep apnea (OSA) identification. We assessed the accuracy of the Alice PDx device with the Somnolyzer automated scoring algorithm, compared to the manually reviewed scoring by a trained sleep technician, for the diagnosis of OSA. Methods A prospective study was conducted between March 2021 and March 2022 in Centro Hospitalar do Baixo Vouga, a level 2 hospital in Aveiro, Portugal. Patients with high pre-test probability for OSA performed a type III home sleep apnea testing with the Alice PDx device. Data were scored automatedly by the Sleepware G3 with the Somnolyzer digital system and manually by a trained sleep technician. Correlation and dependent t-tests were used. Sensitivity, specificity, positive predictive values (PPVs), negative predictive values (NPVs), and area under the receiver operating characteristic curve (AUROC) of automated scoring were calculated. Data were analyzed using the Stata Statistical Software (Release 17, StataCorp., 2023, College Station, TX: StataCorp LLC). Results In 150 participants (mean age 57.8 ± 13.9 years), the mean apnea-hypopnea index (AHI) was 21.9 ± 21.8 events/hour by manual scoring and 25.4 ± 21.6 events/hour by automated scoring. The mean difference was 3.4 ± 4.4 events/hour, and a strong, positive, linear correlation was found between the two scores (r = 0.98). At the altered AHI (AHI ≥ 5 events/hour), mild, moderate, and severe OSA, the automated scoring sensitivity/specificity values were 91.2%/100.0%, 80.0%/68.6%, 91.6%/41.9%, and 98.1%/80.9%, respectively. The PPVs/NPVs for the same categories were 100.0%/69.4%, 89.3%/51.1%, 79.7%/66.7%, and 91.8%/95.0%, respectively. Finally, the AUROC was 0.85, 0.70, 0.73, and 0.93, respectively. Conclusion The automated scoring obtained from the Alice PDx portable device, using Sleepware G3 with the Somnolyzer digital system, seems accurate enough to diagnose OSA and validate the initiation of PAP therapy in the correct clinical setting. Nevertheless, it does not replace manual reviewing by a trained sleep technician in the case of mild and moderate OSA, to obtain a correct severity classification. With this valuable time-saving tool, we expect to hasten OSA diagnosis and treatment and thus tackle the underdiagnosis problem.

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A 30-year-old man who received infliximab for treatment of Crohn's disease developed Epstein-Barr virus (EBV) encephalitis, which responded well to therapy; however, he had left lower visual field loss following treatment. The patient noticed peculiar symptoms 9 months after recovery from encephalitis; objects in his view appeared smaller or larger than their actual size (micropsia/macropsia). Moreover, it appeared that objects outside moved faster or slower than their actual speed of movements and moving objects appeared as a series of many consecutive snap shots. His vision was blurred, and he had visual difficulties and a sensation that his body was floating. These symptoms mainly appeared following fatigue and persisted over approximately 10 years. Based on cerebrospinal fluid analysis, brain MRI, N-isopropyl-p-123I-iodoamphetamine with single photon emission computed tomography, fluorodeoxyglucose positron emission tomography, and electroencephalography, we excluded both recurrent encephalitis and focal epileptic seizures. By taking all symptoms and other evaluation findings into account, the patient most likely suffered from "Alice in Wonderland syndrome" which is primarily associated with cortical dysfunction in the right temporo-parieto-occipital area as the consequence of previous acute EBV encephalitis.

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Alice in Wonderland syndrome (AIWS) is extremely rare, occurring more often in young individuals than in older adults. Symptoms of this syndrome typically include an altered body image, size perception, and time perception. However, the pathophysiology and lesions responsible for this syndrome remain unclear. In most cases, specific lesions cannot be identified using computed tomography or magnetic resonance imaging. Two patients with isolated cortical venous thrombosis in the right occipital area experienced transient visual symptoms of AIWS. Furthermore, a literature search indicated that AIWS with visual distortions is associated with right occipital lobe lesions, supporting the findings of our study.

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Background: The Alice in Wonderland syndrome (AIWS) is a transient neurological disturbance characterized by sensory distortions most frequently associated with migraine in adults. Some lines of evidence suggest that AIWS and migraine might share common pathophysiological mechanisms, therefore we set out to investigate the common and distinct neurophysiological alterations associated with these conditions in migraineurs. Methods: We conducted a case-control study acquiring resting-state fMRI data from 12 migraine patients with AIWS, 12 patients with migraine with typical aura (MA) and 24 age-matched healthy controls (HC). We then compared the interictal thalamic seed-to-voxel and ROI-to-ROI cortico-cortical resting-state functional connectivity between the 3 groups. Results: We found a common pattern of altered thalamic connectivity in MA and AIWS, compared to HC, with more profound and diffuse alterations observed in AIWS. The ROI-to-ROI functional connectivity analysis highlighted an increased connectivity between a lateral occipital region corresponding to area V3 and the posterior part of the superior temporal sulcus (STS) in AIWS, compared to both MA and HC. Conclusion: The posterior STS is a multisensory integration area, while area V3 is considered the starting point of the cortical spreading depression (CSD), the neural correlate of migraine aura. This interictal hyperconnectivity might increase the probability of the CSD to directly diffuse to the posterior STS or deactivating it, causing the AIWS symptoms during the ictal phase. Taken together, these results suggest that AIWS in migraineurs might be a form of complex migraine aura, characterized by the involvement of associative and multisensory integration areas.

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BACKGROUND: Community-level socioeconomic disparities have a significant impact on an individual's health and overall well-being. However, current estimates for poverty threshold, which are often used to assess community-level socioeconomic status, do not account for cost-of-living differences or geography variability. The goals of this study were to compare geographic county-level overlap and gaps in access to care for households within poverty and working poor designations. METHODS: Data were obtained for 21 continental United States (US) states from the United Way's Asset Limited, Income Constrained, Employed (ALICE) households for 2021. Raw data contained the percentage of households at the federal poverty level, the percentage of households at the ALICE designations (working poor), and the total households at the county level. Local Moran's I tests for spatial autocorrelation were performed to identify the clustering of poverty and ALICE households. These clusters were overlaid with a 30-min drive time from critical access hospitals' physical addresses. FINDINGS: County-level clusters of ALICE (working poor) households occurred in different areas than the clustering of poverty households. Of particular interest, the extent to which the 30-min drive time to critical care overlapped with clusters of ALICE or poverty changed depending on the state. Overall, clustering in ALICE and poverty overlapped with 30-min drive times to critical care between 46 and 90% of the time. However, the specific states where disparities in access to care were prominent differed between analyses focused on households in poverty versus the working poor. INTERPRETATIONS: Findings highlight a disparity in equitable inclusion of individuals across the spectrum of socioeconomic status. Furthermore, they suggest that current public health programming and benefits which support low socioeconomic populations may be missing a vulnerable sub-population of working families. Future studies are needed to better understand how to address the health disparities facing individuals who are above the poverty threshold but still struggle economically to meet based needs.

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Alice in Wonderland Syndrome (AIWS) is a rare perceptual disorder, rarely associated with epileptic etiology. We report the case of a 23-year-old man with subacute onset of right peri-orbital headache and visual misperceptions consistent with AIWS Type B, who underwent laboratory tests, brain CT with venography, ophthalmic examination, and neurological assessment that turned out to be normal except for visuospatial difficulties and constructional apraxia. A nasopharyngeal SARS-CoV2 swab taken as screening protocol was positive. The EEG performed because of the persistence of AIWS showed a focal right temporo-occipital non-convulsive status epilepticus; a slow resolution of clinical and EEG alterations was achieved with anti-seizure medications. Brain MRI showed right cortical temporo-occipital signal abnormalities consistent with peri-ictal changes and post-contrast T1 revealed a superior sagittal sinus thrombosis, thus anticoagulant therapy was initiated. AIWS is associated with temporo-parieto-occipital carrefour abnormalities, where visual and somatosensory inputs are integrated to generate the representation of body schema. In this patient, AIWS is caused by temporo-occipital status epilepticus without anatomical and electroencephalographic involvement of the parietal region, consistent with the absence of somatosensory symptoms of the syndrome. Status epilepticus can be the presenting symptom of cerebral venous sinus thrombosis (CVST) which, in this case, is possibly due to the hypercoagulable state associated with COVID-19.

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Migraine is a complex neurological disorder with partially unknown pathophysiological mechanisms. The prevalence in childhood ranges from 7.7% to 17.8%, thus representing the most frequent primary headache. In half of the cases, migraine is accompanied or preceded by various neurological disturbances, among which the visual aura is the best known. In literature, other conditions, such as Alice in Wonderland Syndrome and Visual Snow syndrome, are characterized by visual manifestations and are often associated with migraine. The aim of this narrative review is to describe the spectrum of visual disturbances in pediatric migraine and their pathophysiological mechanisms.

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Temporary and persistent visual phenomena are a frequent reason for a neurological presentation. The diagnosis can usually be made with the help of a structured anamnesis with determination of the time of onset, the course and symptoms as well as the monocular vs. binocular manifestation. The visual aura in migraine is certainly the most frequent entity to be differentiated. In particular, persistent visual phenomena such as visual snow syndrome, hallucinogen persisting perception disorder and the Charles Bonnet syndrome (CBS) seem to be underdiagnosed in clinical practice for various reasons and are probably not that rare. Instrumental diagnostics are mostly used for exclusion diagnostics and are a component of a complete patient education, but can be indicative for certain questions (CBS, epilepsy). This article presents the most frequent visual phenomena from the neurological practice and their differential diagnoses, guided by a case history.

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BACKGROUND AND PURPOSE: Alice in Wonderland syndrome (AIWS) is a neurological disorder characterized by erroneous perception of the body schema or surrounding space. Migraine is the primary cause of AIWS in adults. The pathophysiology of AIWS is largely unknown, especially regarding functional abnormalities. In this study, we compared resting-state functional connectivity (FC) of migraine patients experiencing AIWS, migraine patients with typical aura (MA) and healthy controls (HCs). METHODS: Twelve AIWS, 12 MA, and 24 HCs were enrolled and underwent 3 T MRI scanning. Independent component analysis was used to identify RSNs thought to be relevant for AIWS: visual, salience, basal ganglia, default mode, and executive control networks. Dual regression technique was used to detect between-group differences in RSNs. Finally, AIWS-specific FC alterations were correlated with clinical measures. RESULTS: With respect to HCs, AIWS and MA patients both showed significantly lower (p < 0.05, FDR corrected) FC in lateral and medial visual networks and higher FC in salience and default mode networks. AIWS patients alone showed higher FC in basal ganglia and executive control networks than HCs. When directly compared, AIWS patients showed lower FC in visual networks and higher FC in all other investigated RSNs than MA patients. Lastly, AIWS-specific FC alterations in the executive control network positively correlated with migraine frequency. CONCLUSIONS: AIWS and MA patients showed similar FC alterations in several RSNs, although to a different extent, suggesting common pathophysiological underpinnings. However, AIWS patients showed additional FC alterations, likely due to the complexity of AIWS symptoms involving high-order associative cortical areas.

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Alice in Wonderland syndrome (AIWS) is a rare perceptual disorder characterized mainly by perceptual distortions of visual objects and one's own body. While there are many case reports of visual and somatosensory distortions associated with AIWS, little is known about auditory distortion. Therefore, we present the case of a 22-year-old right-handed woman who described having auditory as well as visual and somatosensory distortion experiences and a family history of AIWS. The subject reported experiencing multisensory perceptual distortions, where she sees other people's faces as larger and hears their voices as louder at the same time. This particular case suggests that auditory distortion - which contributes to constructing the perception of the surrounding space and the body - may also be characterized as a perceptual symptom of AIWS.

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Personal life and achievements are the process and result of a person's past, present, and future interacting with each other. In this regard, if one fully understands the life and background of the person who developed the theory of psychoanalysis, one can understand and use the theory more appropriately. The holding environment theory developed by Donald Woods Winnicott is useful for understanding the process by which infants grow healthy under the care of a mother who is good enough. In this paper, the background of the birth of the holding environment theory is reviewed based on Winnicott's developmental background and marital life. He grew up with a holding environment from good enough 'multiple mothers'. Born with excellent athletic ability and musical talent, he was more curious than anyone else and particularly active in discovering new things. After the unhappy first marriage, Claire Britton's second marriage was happy academically and personally. Claire was a fellow paediatric psychoanalyst who published Winnicott's research and theories after his death. Psychoanalysis or psychotherapy itself can be a holding environment, and the holding environment theory can be applied to various fields in the digital era.

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It is important to examine the effects of the nuclear reaction, which is used as a building material in nuclear reactors. Nuclear reactions occur as a result of the interaction between incident particles with the target nuclei. The charged particle-induced reactions have prime importance in understanding the reaction mechanism which can be applicable to understand the particles resulting from the reaction. It is useful to develop shielding the particle accelerators and fusion reactors. The present study contributes to providing the theoretical prediction of excitation functions for 112Cd (d, 3n)111In, 141Pr (d, 3n)140Nd, 167Er (d, 3n)166Tm, 197Au (d, 3n)196Hg and 209Bi (d, 3n)208Po reactions using theoretical model codes such as TALYS-1.95, EMPIRE-3.2.3, and ALICE-2014 within the incident deuteron energy range of threshold energy to 50 MeV. Also, newly developed (d, 3n) cross-section formula (Kavun, 2020) calculations have been performed for these reactions at 20 MeV of deuteron energy. Lastly, all calculated results have been compared with one another and with the previously published experimental data of the EXFOR database.

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The theoretical model codes ALICE/ASH and TALYS-1.95(G) were used to make theoretical predictions of the production cross-sections of 125I, 124I, 123I, 122I, 121I, 120I, and 119I radionuclides produced in the interaction of proton-projectile with 125Te-target at energies ≈ 5-100 MeV. The results were compared with the measured values in the literature and with TENDL-2019 evaluated data. The Pearson's correlation coefficient indicates a strong and positive correlation between the predicted and the previously measured production cross-sections for medically important 125I, 124I, 123I, and 122I radionuclides. Further, the results show that the TALYS-1.95(G) code predicts more successful outcomes than the ALICE/ASH code for 125I, 124I, 123I, and 122I radionuclides production, which have widespread medical applications, particularly for diagnostic and therapeutic purposes.

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BACKGROUND: A precise evaluation of liver reserve function in patients with hepatic alveolar echinococcosis (HAE) prior to hepatectomy could substantially increase the success rate of the operation and reduce the incidence of postoperative complications. The present study aimed to investigate the significance of the indocyanine green retention test at 15 min (ICG-R15) and the Albumin-Indocyanine Green Evaluation (ALICE) grading system in predicting severe posthepatectomy liver failure (PHLF) and postoperative mortality in HAE patients undergoing liver resection. METHODS: A total of 105 HAE patients undergoing hepatectomy were enrolled in this study. The value of each variable in predicting severe PHLF was evaluated by univariate and multivariate logistic regression analyses. The area under the receiver operating characteristic (ROC) curves (AUC) were calculated to evaluate the predictive ability of the Child-Pugh grade, ICG-R15, and ALICE grading system. Also, patients were classified using the optimal cutoff value for ICG-R15 and different ALICE grades, and the incidence of severe PHLF and postoperative mortality were compared with the predicted values. RESULTS: Out of the 105 HAE patients enrolled in this study, 34 patients (32.4%) developed severe PHLF. The ALICE grade and operative time were identified as independent predictors of severe PHLF. According to ROC analysis, the AUCs of the Child-Pugh grade, ICG-R15, and ALICE grade for predicting severe PHLF were 0.733 (95% confidence interval (CI), 0.637-0.814), 0.823 (95% CI, 0.737-0.891), 0.834 (95% CI, 0.749-0.900). The incidence of severe PHLF and postoperative 90-day mortality in patients with ICG-R15 > 7.2% were significantly higher than those with ICG-R15 ≤ 7.2% (P < 0.001; P = 0.008). Likewise, the incidence of severe PHLF and postoperative 90-day mortality in patients with ALICE grade 2 were higher than those with ALICE grade 1 within the Child-Pugh grade A (P < 0.001; P = 0.083). CONCLUSION: ICG-R15 and ALICE grading system are powerful predictors of severe PHLF and postoperative mortality among HAE patients undergoing hepatectomy. Furthermore, a combination of the preoperative Child-Pugh grade and ALICE grading system may provide an even more precise and objective guidance and facilitate surgical decision-making for HAE patients.

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