Romberg Question

[Krump]

I'm a 59 year old woman who just got a positive Romberg test. I've tried to research what exactly the doctors are looking for and its confusing to me. I've been referred to a neurologist and I have an appt on 4-17-07. Do I need to worry about this?

[Forum-M.D.-SH]

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
     A romberg test is performed by having the patient stand with feet together and close their eyes.  In a positive test (which is abnormal) the patient is able to stand until they close their eyes and then they topple over.  Normal patients are able to maintain their balance with their eyes closed.  This test is non-specific and does not signify a particular disease, but often points to a lesion in the inner ear/vestibular system or a lesion in the cerebellum/proprioception.  When patients have inner ear problems they often have vertigo (causes a room spinning sensation)  and balance problems.  These problems can be compensated some by visual input (which tells you brain that the world is not spinning,etc), but when the eyes are closed then all sense of balance is lost.  The cerebellum is an area of the brain the functions in balance and coordination of motor movements and certain receptors around the body give the cerebellum infromation on where the limbs are in space (call proprioception).  If there is a lesion in the cerebellum or in the receptors of proprioception then these can also imbalance, ataxia, falls, etc.  This deficit can be partially compensated by visual input and closing the eyes while standing takes this away causing the person to fall.  Common problems affecting the cerebellum/proprioception system include strokes, multiple sclerosis, tumors, etc. and some less common causes include neurosyphillis, fredrichs ataxia, spinal cerebellar ataxias etc.)  If the only problem on your neurologic exam is a positive romberg that means the lesion is fairly slight since its affects are totally compensated by visual input when the eyes are open.
I hope this has been helpful.

[BobbHilton]

Hi,
   Romberg test is a part of Balance (Ability to stand up) and Gait (ability to walk) Physical exam Tests.
In my practice I saw few reports from  general physcians, who were overreading the test result especially in  your age group, with no other findings or even any symptomes.
   Simply, we  stand the patient with feet together and compare swaying with eyes open vs. closed (Its crucial to specify the direction of the sway..e.g to the side, backward only or alternating forward/packward ).
    If  swaying with closed eyes --> implies proprioceptive (the accurate sense of the positions of the joint ) or a subtle vestibular abnormality (Inner ear or a central nervous system).
  Some time I do "Fukuda test" (an MRI of the head with GD, gives a much better answer these days), which is marching in place for 50 steps . Abnormal if he/she deviates close to 90 degrees or more left or right. If abnormal, it reflects a subtle vestibular disorder.

(Note: you should never do these tests on your own , without a trained physcian around to prevent falls and injuries!!!!)

   The differential diagnosis depends on the accompanying symptomes with Romberg ...generally it could be in
   1- the peripheral nerve (Either, Large fiber neuropathy or sensory gangionopathy)
   2-Posterior part of the spinal cord
   3-Central nervous system
your neurologist will  (if you have other findings on examination) try to look for  a possible high bood sugar (a subclinical), or B6 level, a possible  low vitamine B12,  vitamine E level, or thyroid function, any rheumatologic causes like Sjogren disease..ext, any abnormal protiens/or cells in your blood, any latent chronic infection, nerve conduction tests and MRI to R/O any structural lesions.

  Bob

[Deb9637]

First of all Krump, sorry for piggybacking on your issues and response from Bob.....but, seems Bob is knowledgeable and from what I've read -  perhaps a physician....So, Bob....can you look at the posts on 3/21 (3 months post ACDF) and tell me what you think with regards to my pending surgery and IF it may help the surges of pressure in my head and associated neurological issues?  As I stated in my post.....Hopes of eliminating that are the ONLY reason I'm considering this surgery.  Thank you if can offer a comment.....Deb

[BobbHilton]

Hi Deb,
  In the first place, Pseudotumor cerebri (PTC) is a disorder of CSF resorption by the micro( small) vessels and not a disease of CSF circulation, thats why the ventricles (the fluid filled cavity in the brain) are not enlarged or even small.
   If, for some reason, they still think this cervical disc is the cause then they should support their case by a head MRI findings!!
   I think , your entire case of pseudotumor cerebri should be presented in a new post (disscussion) mentioning how and when it was diagnosed , what where the presenting symptomes? your weight? were you taking any medication even hurbal/over the counter? what was the CSF opening pressure, was it measured while you were sitting? on your side? especially  there are reports of increased CSF pressure in patients with chronic daily headaches and no papilledema. Many of these patients have analgesic rebound headaches, or a migraine variant (no clear headache, but fullness in the head/ discomfort)
    There is no role for visual evoked potentials,VEP, in this disorder; they are either falsly positive, or unreliable and remain normal, because like glaucoma, PTC generally spares macular function (i.e., visual acuity, central visual field, and color vision) (so if early central loss, abnormal VEP, is a red flag! I mean we should not think of PTC).
      In PTC, we depend on is Stereoscopic fundus photography  which detect a subtle papilledema, and the follw up is not by a clincal exam b but by  a test "Goldmann or Humphery visual filed"

     The last point, what else apart from Diamox ,did you use? any special diet?
     any  attempt to lose weight?

   Bob

[Deb9637]

I keep trying to get a post in here Bob.....I seem to have lousy timing.....Nevertheless, if you'll induldge me for a few moments, I'll try and start at the beginning.