RombergTest

The Romberg test, also known as the Romberg sign, is a neurological examination used to assess proprioception and dorsal column function and to detect sensory ataxia. It helps distinguish sensory ataxia from cerebellar ataxia by testing balance with and without visual input: when vision is removed, individuals with impaired proprioception tend to sway or stumble, whereas those with cerebellar ataxia may be unstable regardless of eyes open or closed.

Procedure: The patient stands with feet together and arms at the sides. First, balance is observed with the eyes open for about 20 to 60 seconds. The patient is then asked to close the eyes for the same period while the examiner watches for swaying, veering, or a fall. In some settings, a tandem stance (heel-to-toe) is used to increase difficulty. A positive test is generally defined as marked instability or loss of balance with the eyes closed, in contrast to relative stability with the eyes open.

Interpretation and limitations: A positive Romberg sign suggests impairment of proprioceptive input (posterior column or large-fiber pathways) leading to sensory ataxia, as seen in conditions such as tabes dorsalis, diabetic neuropathy, B12 deficiency, or other dorsal column diseases. It is not specific for dorsal column pathology and can be influenced by vestibular or cerebellar disorders; a normal test does not exclude these. False positives can occur due to fatigue, anxiety, or improper technique.

Historically, the sign is named after Moritz Heinrich Romberg, a German physician who described it in the 19th century.