August 18, 2008

Noah Klein, MD

Noah Klein, MD, PC

Senator Barak Obama Has a Right Head Tilt 

Watching the Saddleback Church Forum with Pastor Rick Warren interviewing Senator Barack Obama on Saturday August 16, I was struck by the marked and obvious tilting of the Senator’s head Forum. The tilt is to the right side. This phenomenon has not been widely written about from a medical perspective.

A head tilt can be a sign that a patient has double vision also known as diplopia.  Diplopia can be benign if it is caused by a congenital (from birth) eye muscle weakness or it can be associated with autoimmune medical disorders such as thyroid disease or Myasthenia gravis.  Serious medical conditions such as a brain tumor or stroke can also cause it.

The value of looking and observing the entire patient not just their eyes is an invaluable tool for me as an ophthalmologist and doctor.

How does diplopia occur?

Both eyes must work together to create a single image in the brain called binocular vision. In order to avoid double vision both eyes must be focused on the same object and the eyes must perceive the object on the same vertical and horizontal plane. If this alignment is not perfect then the images sent to the brain are` dissimilar and the brain registers two different pictures simultaneously causing double vision.  Double vision is when the brain sees two copies of the same object at the same time. The two objects can be next to each other horizontally causing horizontal diplopia, one on top of the other causing vertical diplopia, or at an oblique angle.

Each eye has six muscles, called extraocular muscles, that control its movements, and those muscles are innervated by four different cranial nerves, the third, fourth, sixth and seventh nerves. Four of the muscles control simple movements such as up, down, right and left, and the other two the inferior and superior oblique muscles are responsible for tilting and rotating the eye. 

A muscle or a cranial nerve disorder can cause an extraocular muscle to be weak or not function at all. As a result the two eyes send dissimilar images to the brain causing the patient to complain of double vision.

A head tilt is frequently seen in patients who are trying to overcome diplopia by turning their head in such a way as to avoid using a certain extraocular muscle. 

Why SENATOR OBAMA’S HEAD tilt is  important

Senator Obama should have a medical evaluation, perhaps even an MRI to determine the cause of his head tilt.  Hopefully the cause is not serious, but early detection is always best.

Dr. Noah Klein

Noah Klein, MD, PC

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