The Romberg sign is a neurological test that evaluates balance and proprioception (sense of body position). Introduced in the mid-19th century by German neurologist Moritz Romberg, it is now a standard part of neurological examinations. It helps clinicians understand how different sensory inputs contribute to maintaining upright posture.
Performing the Romberg Test
For the Romberg test, the individual removes shoes and stands with feet together, heels and toes touching. Arms should be held at their sides or crossed in front of the body. The examiner first observes balance with eyes open for about 30 seconds.
Then, the individual closes their eyes and maintains this position for 30 seconds to one minute. The examiner stays close throughout the test to provide support and prevent falls. The space around the individual should also be cleared of any objects to minimize hazards.
Understanding Romberg Test Results
A “negative” (normal) Romberg’s sign means the individual shows minimal swaying or maintains stability with eyes closed. This indicates intact proprioceptive and cerebellar functions, allowing reliance on internal senses for balance without visual input. Slight, normal swaying is not considered abnormal.
A “positive” Romberg’s sign occurs when the individual sways more or loses balance significantly after closing their eyes. This suggests a proprioceptive deficit, meaning the body’s awareness of its position in space is compromised. Inability to maintain balance without visual cues points to a problem with sensory pathways transmitting proprioceptive information.
Medical Conditions Indicated by a Positive Romberg’s Sign
A positive Romberg’s sign often points to sensory ataxia, a type of incoordination caused by impaired proprioception. This impairment arises from issues affecting the dorsal columns of the spinal cord or peripheral nerves, which relay sensory information about body position to the brain.
One historical condition linked to a positive Romberg’s sign is Tabes Dorsalis, a late stage of neurosyphilis. This condition damages the dorsal columns of the spinal cord, disrupting proprioceptive pathways. Similarly, Vitamin B12 deficiency can lead to subacute combined degeneration of the spinal cord, also impacting the dorsal columns and causing sensory ataxia.
Peripheral neuropathies, involving damage to nerves outside the brain and spinal cord, can also result in a positive Romberg’s sign. Conditions like diabetes and alcoholism are common causes of peripheral neuropathy, leading to impaired sensation in the limbs. Certain forms of multiple sclerosis, a disease affecting the central nervous system, can also involve lesions in the spinal cord’s posterior cord pathway, manifesting as truncal instability and a positive Romberg’s sign.