Romberg’s test is a physical exam maneuver done as part of a thorough neurologic exam. In the test, patients are asked to maintain a standing position while keeping their eyes closed. A positive test result, indicated by loss of stability or falling, can indicate disease in the posterior aspect of the spinal cord. It could also indicate having inner ear problems. More rarely, patients with disease of the cerebellar region of the brain could also develop a positive result.
In order the perform Romberg’s test, a patient is asked to stand up with his or her feet parallel and positioned close to each other. Sometimes patients are asked to stretch their arms out with their palms facing up, but it is not required in order to get an accurate result from the test. Patients are then asked to close their eyes and maintain the standing position without falling. A positive, or abnormal, result occurs when the patient becomes unsteady, swaying back and forth and perhaps even falling. If patients are able to maintain a stable standing position, then the test is considered to be negative and normal.
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Having a positive Romberg’s test typically points towards the presence of pathology in the central nervous system. Specifically, it typically indicates the presence of disease in the posterior part of the spinal cord, a region that controls a patient’s ability to sense position in space. With disease in this part of the spinal cord, the nerves that sense position in the legs do not work, and without this input to the brain, the body cannot adequately maintain a standing position. When the eyes are open, this deficit is typically compensated for by using visual clues, and the patient can maintain balance.
A number of different diseases and other conditions can cause a positive Romberg’s test. Having a vitamin B12 deficiency is one cause of a positive result. Advanced syphilis can also damage the posterior spinal cord, leading to the postural instability associated with a positive test. Other conditions such as Guillain-Barre syndrome, multiple sclerosis, transverse myelitis, and chronic inflammatory demyelinating polyneuropathy could also cause positive test results.
Occasionally, having problems in the workings of the inner ear can also cause a patient to have a positive Romberg’s test. This part of the body also helps people to maintain balance. Conditions such as labyrinthitis, benign positional vertigo, acoustic neuroma, and migraine-associated vertigo could cause positive results because they interfere with the workings of the inner ear.