Differential Diagnosis for Positive Romberg Test after Two Weeks on a Cruise
The Romberg test is used to assess a patient's balance and proprioception. A positive test indicates a problem with balance, which can be caused by various conditions. Given the context of being on a cruise, we can consider the following differential diagnoses:
- Single most likely diagnosis
- Mal de Débarquement Syndrome: This condition is characterized by a feeling of imbalance and unsteadiness after being on a boat or ship for an extended period. It is a common issue for people who have been on cruises, and the symptoms can last for several weeks after disembarking.
- Other Likely diagnoses
- Vestibular dysfunction: Prolonged exposure to the motion of the ship can cause temporary vestibular dysfunction, leading to imbalance and a positive Romberg test.
- Benign Paroxysmal Positional Vertigo (BPPV): Although not directly related to being on a cruise, BPPV is a common cause of vertigo and imbalance, and the motion of the ship may have triggered or exacerbated the condition.
- Inner ear infection: An inner ear infection, such as labyrinthitis, can cause imbalance and a positive Romberg test.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Stroke or Transient Ischemic Attack (TIA): Although less likely, a stroke or TIA can cause sudden onset of imbalance and a positive Romberg test. It is essential to rule out these conditions, as they require immediate medical attention.
- Multiple Sclerosis: In rare cases, multiple sclerosis can cause acute onset of imbalance and a positive Romberg test.
- Vestibular schwannoma: A vestibular schwannoma is a rare tumor that can cause imbalance and a positive Romberg test.
- Rare diagnoses
- Meniere's disease: This is a rare inner ear disorder that can cause episodes of vertigo, tinnitus, and hearing loss, leading to a positive Romberg test.
- Ototoxicity: Certain medications or substances can cause ototoxicity, leading to damage to the inner ear and resulting in imbalance and a positive Romberg test.