Romberg Test

Excerpt

The Romberg's sign or Romberg's test is named after a European neurologist, Mortiz Romberg; historically, this was described by Marshall Hall, Moritz Romberg, and Bernardus Brach. Initially, this sign was tethered specifically with tertiary syphilis patients who exhibited neurologic signs of late-stage disease referred to as locomotor ataxia or tabes dorsalis.

When examining a patient's neurological effects from sequelae involving late-stage syphilis, the Romberg sign became a precise test to determine the integrity of the dorsal column pathway of the brain and spinal cord, which controls proprioception. Proprioception is the sense of awareness of the position and movement of the body. Romberg described this sign as a severe postural impairment in a darkroom setting or with eyes closed of patients with severe damage to the posterior dorsal columns of the spinal cord. Used as a precise clinical tool, the Romberg test is positive if a patient cannot maintain an upright stance with vision eliminated or in the darkness.

Often the Romberg test can be confused as a sign of cerebellar disease, but this test demonstrates the effects of posterior column disease. Normal stance in a person is governed by the integrity of vision, proprioception, and vestibular function. The ability to gauge actual proprioception status can be confounded by the vestibular and vision somatosensory system, which may compensate for vestibular function and vision. The Romberg sign removes the visual and vestibular components that contribute to maintaining balance and can thus identify a proprioception-related neurologic disease.

The Romberg sign is said to be positive in a patient who can stand with his feet placed together and eyes open but paradoxically sways or falls while closing his eyes, thereby eliminating his visual cues.