EpistemisPositive Romberg sign
Specialty: Neurology.
Why it occurs
- Subacute combined degeneration of the spinal cord (myelopathy due to vitamin B12 deficiency with posterior cord damage)
- Neurosyphilis (Tabes dorsalis, demyelination of the posterior horns and dorsal root ganglia)
- Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)
- Coarse fiber sensory neuropathy (diabetic, idiopathic, autoimmune)
- Severe bilateral vestibulopathy (toxicity due to aminoglycosides such as gentamicin)
Initial workup
Performing the Romberg maneuver (ask the patient to remain upright with feet together, first with eyes open and then closed, observing the oscillation or loss of balance with eyes closed); dosage of serum Vitamin B12, methylmalonic acid, luetic serology (VDRL/FTAs in blood and CSF); electroneuromyogram (ENMG); MRI of the cervical and dorsal spine focused on the posterior cords.
red flags
Immediate loss of balance when closing the eyes with sudden and uncontrolled falls, associated with ascending muscle weakness in the lower limbs, areflexia or rapidly progressive paresthesias in the trunk (suggests transverse myelitis or sensitive Guillain-Barré).
Standard management
- Hydroxocobalamin — 1000 mcg intramuscularly in loading regimen and immunosuppression if there is a deficiency
- Crystalline penicillin G sodium — 18-24 million units daily intravenously for 10-14 days if neurosyphilis is confirmed
- Intravenous immunoglobulin in case of predominantly sensory CIDP.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 5
- Treatment options
- 3