Optic disc drusen as a diagnostic confounder in a child with Alice in Wonderland syndrome.

Abstract

We report the case of a 10-year-old boy referred for transient visual episodes compatible with Alice in Wonderland syndrome, described as a sensation that objects were moving away. Ophthalmic examination showed preserved visual acuity and an unremarkable anterior segment, but revealed elevation of the left optic disc, prompting evaluation for true papilledema. Macular OCT was normal, whereas optic nerve head OCT demonstrated structural asymmetry consistent with pseudopapilledema. Brain and orbital MRI showed isolated enlargement of both optic nerve sheaths and mild elevation of the left optic disc, without additional findings suggestive of intracranial hypertension. Orbital ultrasonography identified a hyperechogenic focus suggestive of optic disc drusen. The stable clinical and structural course supported the diagnosis of unilateral pseudopapilledema due to optic disc drusen, probably unrelated to the perceptual symptoms.