Romberg test

[Apoplexy__]

I feel stupid for asking this, but my confusion only arose because I heard Goljan emphasize that Romberg was NOT a cerebellar test and rather a proprioceptive test. I figure he must have meant something else, because my understanding was that it simultaneously tested vestibular, cerebellar, and proprioceptive functions. I have two questions regarding this:

1. Does the Romberg test assess anything other than those 3 systems I mentioned?
2. Can you localize the lesion based on different steps of the test? (e.g. I imagine imbalance with eyes closed but not with eyes open is more indicative of proprioceptive rather than the other 2 etiologies)

Thanks.

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[ChessMaster3000]

I feel stupid for asking this, but my confusion only arose because I heard Goljan emphasize that Romberg was NOT a cerebellar test and rather a proprioceptive test. I figure he must have meant something else, because my understanding was that it simultaneously tested vestibular, cerebellar, and proprioceptive functions. I have two questions regarding this:

1. Does the Romberg test assess anything other than those 3 systems I mentioned?
2. Can you localize the lesion based on different steps of the test? (e.g. I imagine imbalance with eyes closed but not with eyes open is more indicative of proprioceptive rather than the other 2 etiologies)

Thanks.

So, technically speaking:
Romberg test is only positive if the patient has intact balance with eyes OPEN but impaired balance with eyes CLOSED. If the patient has trouble with eyes OPEN (and, by extension, he will surely have impaired balance with eyes closed also), it is not a positive romberg test and that is probably more indicative of cerebellar etiology. The reason Romberg is a proprioceptive test is because it only applies when the patient has a discrepancy regarding balance with eyes open and with eyes closed. An easy way to justify this is you need 2 out of the 3 systems working at any given time to maintain balance.

If your eyes are closed, those are out, and if you have impaired proprioception, that's out, thus you are only relying on cerebellum and will have impaired balance (positive romberg).

If your eyes are open, and you still have trouble with balance, what does that mean? (If you can answer this, then I think you understand my horrible explanation)

 

[Myxedema]

To maintain gait, you need:
(a) positional sense (comes from visual, vestibular, and proprioceptive input)
(b) motor output (both corticospinal tract and basal ganglia)
(c) integration of senses with motor output (cerebellum)
A problem in any of the three can result in an abnormal gait. If there is a problem with the vestibular or proprioceptive input, then the body would have to rely on visual input to coordinate and execute motor output to maintain gait. By closing the eyes, the last remaining sensory input would be gone as well, and the patient would fall (Romberg test positive). Now compare it with someone who has cerebellar damage. In such a patient, even with eyes open, he wouldn't be able to maintain gait, as the issue is not with the input, but how that input is coordinated to the motor output (Romberg test negative).

 

[Apoplexy__]

The reason Romberg is a proprioceptive test is because it only applies when the patient has a discrepancy regarding balance with eyes open and with eyes closed.

To maintain gait, you need:
(a) positional sense (comes from visual, vestibular, and proprioceptive input)
(b) motor output (both corticospinal tract and basal ganglia)
(c) integration of senses with motor output (cerebellum)

Great stuff, thanks a lot guys.