Romberg Test

Abstract

The Romberg's sign or Romberg's test is a phenomenon named by 19th-century European neurologist, Mortiz Romberg. 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.[1] 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 who had 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 is unable to maintain an upright stance with vision eliminated or in the darkness.[1]  Often the Romberg test can be confused as a sign of cerebellar disease, but instead, this test demonstrates the effects of posterior column disease. The ability to gage true proprioception status can be confounded by the vestibular and vision somatosensory system, which may compensate with vestibular function and vision.[2] The Romberg sign removes the visual and vestibular components that contribute to maintaining balance, and can thus identify specifically a proprioception-related neurologic disease.