The Romberg test is a simple neurological examination used to assess balance. Developed by Moritz Romberg in the 19th century, it initially helped diagnose late-stage syphilis. Today, it evaluates equilibrium and differentiates balance issues by examining sensory system contributions.
Performing the Romberg Test
To perform the Romberg test, the individual is asked to remove their shoes and stand with both feet together. Their arms should be held at their sides or crossed in front of their body. The examiner first observes the individual’s balance for approximately 30 seconds while their eyes are open, noting any swaying.
Following this, the individual is instructed to close their eyes and maintain the same standing position for another 30 to 60 seconds. The examiner observes for increased swaying, foot movement, or loss of balance. The examiner stands nearby to ensure safety and prevent falls.
Understanding a Positive Result
A “positive Romberg sign” occurs when an individual sways or loses balance only with eyes closed, but maintains balance with eyes open. This indicates a deficit in proprioception, the body’s ability to sense its position and movement in space. Balance relies on three sensory inputs: vision, proprioception, and the vestibular system (inner ear, sensing head position and movement).
When vision is available, it can compensate for a proprioceptive deficit, allowing the individual to maintain balance. However, when visual input is removed by closing the eyes, the underlying proprioceptive problem becomes apparent, leading to instability. This suggests a dysfunction within the dorsal columns of the spinal cord or peripheral nerves, which are responsible for transmitting proprioceptive information to the brain.
Conditions Associated with a Positive Romberg Sign
A positive Romberg sign points to conditions that impair proprioception. Historically, it was associated with tabes dorsalis, a neurological complication of late-stage syphilis affecting the spinal cord’s dorsal columns. Though less common today, the test identifies other neurological conditions.
Vitamin B12 deficiency can lead to a positive Romberg sign. This deficiency can cause subacute combined degeneration of the spinal cord, directly impacting the proprioceptive pathways. Peripheral neuropathy, a type of nerve damage often seen in conditions like diabetes or alcoholism, can affect the sensory nerves responsible for proprioception, resulting in a positive test. Multiple sclerosis, a disease that involves the demyelination of nerve cells in the central nervous system, can also affect the dorsal columns and lead to proprioceptive loss, contributing to a positive Romberg sign.
Romberg Test vs. Other Balance Problems
The Romberg test is distinct because it primarily identifies balance issues stemming from proprioceptive deficits. Individuals with cerebellar problems (e.g., stroke, tumor, alcohol intoxication) exhibit balance difficulties even with eyes open. Their instability is not compensated by vision because cerebellar ataxia originates from a different brain region responsible for coordination, not solely sensory input. Thus, a person with cerebellar ataxia will not show a classic positive Romberg sign, as their balance is already compromised regardless of visual input. Severe vestibular issues, affecting the inner ear, can cause balance disturbances and vertigo.
While some vestibular problems might lead to swaying with eyes closed, they often present with nystagmus (involuntary eye movements) or consistent sway in a particular direction. The Romberg test differentiates sensory ataxia (proprioceptive) from cerebellar ataxia, providing a diagnostic clue by highlighting problems unmasked when visual compensation is removed.