From the Guidelines
Romberg's test is a crucial neurological examination that evaluates balance and proprioception, and a positive Romberg's sign, characterized by swaying with eyes closed but correcting with eyes open, suggests a problem with proprioception rather than cerebellar dysfunction. This finding typically points to posterior column dysfunction in the spinal cord, which carries proprioceptive information from the body to the brain, as noted in the study by 1. Common causes of this dysfunction include vitamin B12 deficiency, tabes dorsalis (neurosyphilis), sensory peripheral neuropathies, and multiple sclerosis.
Key Points to Consider
- The test works because vision normally compensates for mild proprioceptive deficits; when visual input is removed by closing the eyes, the balance impairment becomes apparent, as discussed in 1.
- To perform the test properly, have the patient stand with feet together and arms at their sides, first with eyes open to establish a baseline, then with eyes closed for 20-30 seconds while observing for increased swaying or loss of balance.
- Significant swaying or falling with eyes closed that improves with eyes open suggests posterior column dysfunction requiring further neurological evaluation, including vitamin B12 levels, syphilis testing, nerve conduction studies, or MRI depending on the clinical context, as suggested by 1.
Clinical Implications
- The study by 1 highlights the importance of evaluating the coexisting central abnormalities of the cerebellum and brainstem in patients with sensory or proprioceptive ataxia.
- The combination of cerebellar ataxia and sensory neuropathy can contribute to symptoms of disequilibrium, and neuroimaging is primarily directed at evaluating these central abnormalities, as noted in 1.
- Diagnostic confirmation of autoimmune sensory ataxic neuropathies is generally via clinical evaluation and electrodiagnostic testing, as discussed in 1.
Recommendations for Practice
- Performing Romberg's test is essential in the neurological examination of patients with balance and proprioception issues, as it can help identify posterior column dysfunction and guide further evaluation and management, as suggested by 1 and 1.
- Clinicians should be aware of the common causes of posterior column dysfunction and consider these in their differential diagnosis when a patient presents with a positive Romberg's sign, as discussed in 1 and 1.
From the Research
Romberg's Test
- The Romberg test is a clinical test used to assess a person's balance and proprioception (sense of body position) 2.
- The test involves standing with feet together and eyes closed, and it is often used to diagnose distal proprioceptive impairment.
- However, research has shown that standing with eyes closed on a compliant surface is more a test of vestibular function than proprioceptive function 2.
Swaying with Eyes Closed
- Swaying with eyes closed during the Romberg test can indicate a problem with vestibular function or proprioception 2.
- The vestibular system, which includes the semicircular canals and otolith organs, plays a crucial role in maintaining balance and spatial orientation 2.
- Damage to the vestibular system or proprioceptive pathways can cause swaying or loss of balance during the Romberg test.
Correcting with Eyes Open
- When a person opens their eyes during the Romberg test, they are able to use visual input to help correct their balance and reduce swaying 2.
- This suggests that the visual system is able to compensate for deficits in vestibular or proprioceptive function to some extent.
- However, the ability to correct balance with eyes open does not necessarily rule out underlying vestibular or proprioceptive problems.
Relationship to Vitamin B12 Deficiency
- There is no direct evidence in the provided studies to suggest a link between Romberg's test and vitamin B12 deficiency 3, 4, 5, 6.
- However, vitamin B12 deficiency can cause peripheral neuropathy, which can affect balance and proprioception 3, 4, 5, 6.
- Further research would be needed to determine if there is a relationship between vitamin B12 deficiency and performance on the Romberg test.