The Romberg Sign and its Clinical Significance

O Sinal de Romberg e sua Significância Clínica

Samuel Pedro Pereira Silveira
Elvis Edmar Cora Sobrinho
Henrico Garchet Batistela
Izadora Herrera Frasson Matheus
Luan da Silva Marques
Paulo Fernandes dos Santos Júnior
Carlos Umberto Pereira
Roberto Alexandre Dezena

https://doi.org/10.22290/jbnc.2025.360111
J Bras Neurocirur 36 (1):48-53, 2025

Views: 365

Downloads: 29

Resumo

O teste de Romberg é uma ferramenta essencial na avaliação neurológica, utilizada para investigar a integridade das vias proprioceptivas, incluindo as colunas dorsais da medula espinhal e o sistema vestibular. De grande relevância histórica e clínica, suas descrições originais remontam a Moritz Heinrich Romberg, que consolidou sua importância semiológica e diagnóstica. O teste consiste em avaliar o equilíbrio do paciente com os olhos abertos e fechados, permitindo a identificação de disfunções proprioceptivas. Suas variações, como os testes de Romberg em tandem e em marcha, aumentam a sensibilidade em condições como mielopatia cervical e esclerose múltipla. Apesar de sua utilidade clínica, o teste apresenta limitações, como a variabilidade na interpretação e sensibilidade a déficits não proprioceptivos. Este artigo discute o desenvolvimento histórico, a fisiopatologia e as implicações clínicas do teste de Romberg, destacando a importância de sua integração com tecnologias avançadas para aprimorar a precisão diagnóstica.

Palavras-chave

Ataxia; Neurológico, exame; Romberg, teste; Vestibular, sistema

Abstract

The Romberg test is a fundamental tool in neurological evaluation, assessing the integrity of proprioceptive pathways, including the dorsal columns of the spinal cord and vestibular system. This historical and clinically significant test traces its origins to Moritz Heinrich Romberg, who established its semiological and diagnostic importance. The test involves observing balance with eyes open and closed, providing insight into proprioceptive dysfunction. Variations, such as the tandem and walking Romberg tests, enhance sensitivity for conditions like cervical myelopathy and multiple sclerosis. Despite its clinical utility, the test’s limitations include variability in interpretation and sensitivity to non-proprioceptive deficits. This article explores the historical development, pathophysiology, and clinical implications of the Romberg test, advocating for its integration with technological advancements to improve diagnostic accuracy.

Keywords

Ataxia; Neurologic examination; Romberg test; Vestibular system

References

1. Binder MD, Hirokawa N, Windhorst U, editors. Encyclopedia of Neuroscience. Berlin: Springer; 2009. Romberg sign; p. 3553-4. http:// doi.org/10.1007/978-3-540-29678-2_5172.

2. Schiffter R. Moritz Heinrich Romberg (1795-1873). J Neurol. 2010;257(8):1409-10. http://doi.org/10.1007/s00415-010-5552-1. PMid:20461399.

3. Karenberg A, Fangerau H, Steinmetz H, Berlit P, Grond M. Historical review: a short history of German neurology: from its origins to the 1940s. Neurol Res Pract. 2019;1(1):14. http://doi.org/10.1186/s42466- 019-0019-z. PMid:33324880.

4. Housman B, Bellary SS, Walters A, Mirzayan N, Tubbs RS, Loukas M. Moritz Heinrich Romberg (1795-1873): early founder of neurology. Clin Anat. 2014;27(2):147-9. http://doi.org/10.1002/ca.22112. PMid:22711686.

5. Jacobi E. The neurologist Moritz Heinrich Romberg 1795-1873 [dissertation]. Zurich: University of Zurich; 1965.

6. López-Hernández JC, Violante Villanueva A. Romberg sign: historical conception. Arch Neurocienc. 2023;28(2):49-53. http://doi. org/10.31157/an.v28i2.443.

7. Schiffter R. Biographical sketches of Romberg. Fortschr Neurol Psychiatr. 2007;75(3):160-7. http://doi.org/10.1055/s-2006-944319. PMid:17450632.

8. Romberg MH. De Rhachitide Congenita [dissertation]. Berlin: Faculty of Friedrich Wilhelms, University of Berlin; 1817. Archive of Humboldt University of Berlin.

9. Kreissl J. Progressive positions in the life and work of Moritz Heinrich Romberg [dissertation]. Berlin: Faculty of Humboldt, University of Berlin; 1964.

10. Romberg MH. Textbook of human nervous diseases. Berlin: Duncker; 1851.

11. García Pastor C, Álvarez Solís GA. The Romberg test and Moritz Heinrich Romberg. Rev Mex Neuroci. 2014;15(1):31-5.

12. Lanska DJ, Goetz CG. Romberg’s sign: development, adoption, and adaptation in the 19th century. Neurology. 2000;55(8):1201-6. http:// doi.org/10.1212/WNL.55.8.1201. PMid:11071500.

13. Berge JE, Goplen FK, Aarstad HJ, Storhaug TA, Nordahl SHG. The Romberg sign, unilateral vestibulopathy, cerebrovascular risk factors, and long-term mortality in dizzy patients. Front Neurol. 2022;13:945764. http://doi.org/10.3389/fneur.2022.945764. PMid:35989919.

14. Greenberg DA, Aminoff MJ, Simon RP. Clinical neurology. 8th ed. Porto Alegre: ArtMed; 2014.

15. Ito M, Matsuno K, Sakumoto Y, Hirata K, Yuki N. Ataxic Guillain- Barré syndrome and acute sensory ataxic neuropathy form a continuous spectrum. J Neurol Neurosurg Psychiatry. 2011;82(3):294-9. http://doi. org/10.1136/jnnp.2010.222836. PMid:21252265.

16. Malek E, Doumiati H, Salameh J. Pyridoxine-induced sensory ataxic ganglionopathy: a case report and literature review. Acta Neurol Belg. 2020;120(2):413-4. http://doi.org/10.1007/s13760-018-0919-7. PMid:29705938.

17. Abdul Razzak R, Hussein W. Postural visual dependence in asymptomatic type 2 diabetic patients without peripheral neuropathy during a postural challenging task. J Diabetes Complications. 2016;30(3):501-6. http://doi.org/10.1016/j.jdiacomp.2015.12.016. PMid:26774792.

18. Makwana D, Deepakkumar P, Wadkar P. Vitamin B12 concentrations and clinical spectrum of apparently healthy elderly population. Perspect Med Res. 2020;8(1):48-54. http://doi.org/10.47799/pimr.0801.10.

19. Findlay G, Balain B, Trivedi J, Jaffray D. Does walking change the Romberg sign? Eur Spine J. 2009;18(10):1528-31. http://doi.org/10.1007/ s00586-009-1008-7. PMid:19387702.

20. Carpinella I, Anastasi D, Gervasoni E, et al. Balance impairments in people with early-stage multiple sclerosis: boosting the integration of instrumented assessment in clinical practice. Sensors (Basel). 2022;22(23):9558. http://doi.org/10.3390/s22239558. PMid:36502265.

21. Steffen T, Seney M. Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with parkinsonism. Phys Ther. 2008;88(6):733-46. http://doi.org/10.2522/ ptj.20070214. PMid:18356292.

22. Mezenchuk AI, Kubryak OV. Romberg’s sign: from walking in the dark to tests on the force plate. Almanac Clin Med. 2022;50(5):335-47. http://doi.org/10.18786/2072-0505-2022-50-040.

23. Seo NY, Jeong EW, Lee JH, Cho SY, Jung YJ. Objective assessment of motor ataxia via quantitative analysis of Romberg’s test utilizing webcam-based motion capture with AI. J Magn. 2023;28(4):470-6. http://doi.org/10.4283/JMAG.2023.28.4.470.

1Faculty of Medicine, Universidade Federal do Triângulo Mineiro – UFTM, Uberaba, MG, Brazil.

2Universidade Federal de Sergipe – UFS, Aracaju, SE, Brazil.

3Discipline of Neurosurgery, Hospital das Clínicas, Universidade Federal do Triângulo Mineiro – UFTM, Uberaba, MG, Brazil.

Received Dec 22, 2024

Accepted Dec 27, 2024