Romberg Test

This morning we talked about the Romberg test.

The ability to maintain a steady posture depends on input from 2 of the 3:
o vestibular apparatus
o eyes
o propioception from feet
The cerebellum coordinates the input from all three.

ROMBERG test tells you about problems in propioception or the vestibular apparatus.
The test start with the patient standing with heels together and eyes OPEN. If there is unsteadiness, then there is cerebellar ataxia. If the patient is steady, then ask the patient to stand with eyes CLOSED. Inability to stand for 60 seconds with eyes CLOSED is a positive Romberg sign, and reflects vestibular disease or sensory ataxia.

*The test was named after the German neurologist Moritz Romberg (1795-1873).

Ref: Evidence-Based Physical Diagnosis, McGee. 2007.

Equilibrium

Today in morning report a few of the presented cases had disorders of equilibrium with the two cardinal symptoms of either vertigo – an illusion of bodily or environment spinning- or ataxia- incoordination of limbs or gait.

Disorders of disequilibrium can be produced by conditions that affect the vestibular pathways, the cerebellum, or sensory pathways in the spinal cord or peripheral nerves.

We considered the diagnosis of stroke in all of the above cases. A recent article in CMAJ called "Does my dizzy patient have a stroke" addresses that same question. Here is the article.

*Jean Louis Forain's 19th Century Tightrope Walker. How many organ systems is the performer using to maintaining her balance in the dark?