Talk:Romberg's test

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[edit] Question 1

As far as I´m concerned the Romberg test is used to decide whether or not the cerebellum is affected - that Romberg shows that cerebellum can be affected...? "Symptoms when affections of the cerebellum, peripheral nerves and so on" - Danish clinical dictionary

- Viktor, danish stud.med

Hello Viktor, and thanks for bringing this up. I can see you're a bit confused about this, so let's see if I can help. The cerebellum provides the motor control that allows people to maintain balance by integrating three types of sensory input: vestibular (inner ear and eight cranial nerves), proprioceptive (peripheral nerves and dorsal columns of the spinal cord), and visual (eyes and second cranial nerves).

Now, Romberg's test evaluates postural instability in an ataxic patient standing with his/her feet together. If postural instability is markedly worsened by closing his/her eyes (i.e. by eliminating the visual input), Romberg's test is positive and that means the patient has sensory ataxia, i.e. loss of spinal proprioception. In other words, the proprioceptive input is impaired due to a disease process, so the cerebellum relies heavily on the other two types of input to maintain balance; if you take away a second input (visual) by closing the eyes, the cerebellum is left with not enough data to elaborate motor instructions and the patient's instability worsens markedly.

On the other hand, if the patient's postural instability stays pretty much the same whether the eyes are closed or not, Romberg's test is negative, and that means that the patient has cerebellar ataxia, i.e. dysfunction of the cerebellum (in this case mainly of the flocculo-nodular lobe, which is concerned with postural stability). In other words, it doesn't matter whether visual input is available or not, the cerebellum cannot maintain balance anyway because it is not functioning properly.

Hope that clears it up.  :) --Nehwyn 17:25, 23 June 2007 (UTC)

Re: Contradiction - I see no contradiction at all in that section. —Preceding unsigned comment added by 128.40.46.84 (talk • contribs)

"With severe intoxication a positive Romberg is seen even with open eyes or in the sitting position" contradicts the statement that "The test is not positive if..The patient falls when the eyes are open" Bartleby 04:41, 16 August 2007 (UTC)

It is a contradiction, and it's blatantly wrong. I've removed the sentence. --Nehwyn 21:04, 22 August 2007 (UTC)

Thanks. I didn't know which was correct. Bartleby 04:39, 23 August 2007 (UTC)

[edit] Question 2

I thought that Romburg's test was used as an ENT test looking at the function of the vestibule - standing up straight with the feet together minimises the proprioception, and closing the eyes removes vision so the only balance organ remaining is the vestibule and vestibulocochlear nerve? - Bex, third year medical student —Preceding unsigned comment added by BexW (talk • contribs) 01:00, 7 October 2007 (UTC)

No, Romberg's test is used to differentiate cerebellar from sensory ataxia, not to evaluate vestibular ataxia. Peripheral causes of vestibular dysfunction are usually very obvious to discern, whereas central causes may be subtler, and do overlap with other causes of ataxia. Still, vestibular dysfunction tends to cause full-blown dysequilibrium (that's not the same as "postural instability", which is what the Romberg test evaluates), and is better assessed by stabilometry (for vestibulo-spinal function) and eye movements (for vestibulo-oculomotor function). --Nehwyn 07:34, 7 October 2007 (UTC)