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Romberg maneuver: symptoms and causes
Three things to maintain standing posture: visual information, vestibular function, and sense of being. Note that the majority of patients with cerebellar damage cannot maintain balance even though visual cues remain.
Description
The patient is asked to stand with their feet together, eyes closed, and maintain that position for 60 seconds. If the patient is unable to stand for the 60s with legs folded and eyes closed, the test is positive.
Causes
Common
Peripheral sensory neuropathy.
Vestibular nerve inflammation.
Drugs with vestibular toxicity (eg. Furosemide, gentamicin).
Less common
Degenerative bone marrow-associated degeneration (lack of Vitamin B12).
Tabes dorsalis disease (eg. Stage 3 syphilis).
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Cerebellar surgery |
Function |
The movement path involved |
|
Worm and velvet lobe |
• Coordination of the proximal limb and body • Vestibular reflexes |
• Anterior bundle of the pulp • A bundle of thorn net • Prickly vestibules • Roof-marrow bundles |
Board. Anatomy of the cerebellum and related motor pathways
Mechanism
Three things to maintain standing posture: visual information, vestibular function, and sense of being. Note that the majority of patients with cerebellar damage cannot maintain balance even though visual cues remain.
A positive Romberg test is caused by:
Disorder in the sense of being.
Vestibular dysfunction.
Disorder in the sense of being
In a patient with mild loss of sense of identity, visual information may be sufficient to compensate and maintain a stable posture. Therefore, when there is a loss of visual input, the compensation is no longer sufficient to maintain a stable posture, resulting in a positive Romberg test. Causes include peripheral sensory neuropathy and posterior columnar dysfunction (eg. Tabes disease, subacute myelosuppression).
Vestibular dysfunction
In patients with vestibular dysfunction (eg vestibular neuritis). Visual information can be sufficient to eliminate distractions and maintain a steady posture. With the loss of visual information, dizziness and/or loss of balance cause posture instability.
Meaning
In one study, 153 patients (115 in normal health, 13 patients with ataxia, and 25 patients with ataxia) were evaluated by the Romberg maneuver (positive test is for ataxia). a human cannot stand the 60s with legs pinched, eyes closed). All healthy cases were negative. Half of the patients with ontological disorder previously only standing for 10 seconds had a positive test.