What’s the Romberg test?

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The Romberg test is a physical exam maneuver performed as part of a thorough neurological exam. In the test, patients are asked to maintain an upright position with their eyes closed. A positive test result, indicated by loss of stability or a fall, may indicate disease in the posterior aspect of the spinal cord. It could also indicate inner ear problems. More rarely, patients with disease in the cerebellar region of the brain might also develop a positive result.

To perform the Romberg test, the patient is asked to stand with the feet parallel and placed close together. Sometimes patients are asked to stretch their arms with their palms facing up, but it is not necessary to get an accurate result from the test. Patients are then asked to close their eyes and maintain an upright position without falling over. A positive, or abnormal, result occurs when the patient becomes unsteady, rocks back and forth, and possibly even falls. If patients are able to maintain a stable upright position, the test is considered negative and normal.

Having a positive Romberg test typically indicates the presence of pathology in the central nervous system. In particular, it typically indicates the presence of disease in the back of the spinal cord, a region that controls the patient’s ability to perceive position in space. With disease in this part of the spinal cord, the nerves that sense position in the legs fail, and without this input to the brain, the body cannot adequately maintain an upright position. When the eyes are open, this deficit is usually compensated for using visual cues and the patient can maintain balance.

Several diseases and other conditions can cause a positive Romberg test. Having a vitamin B12 deficiency is one of the causes of a positive result. Advanced syphilis can also damage the posterior spinal cord, leading to 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 with the functioning of the inner ear can also cause a patient to have a positive Romberg test. This part of the body also helps people maintain balance. Conditions such as labyrinthitis, benign positional vertigo, acoustic neuroma, and migraine-associated vertigo could cause positive results because they interfere with inner ear functioning.

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