Diagnosis of Parry Romberg Syndrome

• Cerebellar dysfunction
  –Multiple causes (e.g., CVA, brain tumor)
  –Most patients with midline cerebellar dysfunction have difficulty standing on a narrow base; this effect will not appreciably worsen with eye closure
• Vestibular dysfunction (peripheral)
• Drug intoxication
  –Alcohol
  –Cisplatin
  –Pyridoxine (vitamin B₆) overdose
  –Anticonvulsant toxicity (especially
  phenytoin) may cause difficulty standing on a narrow base, but this may not necessarily worsen with eye closure
• Friedreich's ataxia
• Miller-Fisher variant of Guillain-Barré syndrome
• Paraneoplastic sensory neuropathy
• Vitamin E deficiency

Workup and Diagnosis

• History and physical examination with comprehensive neurologic examination
  –Elicit Romberg test
  –Be sure to focus on other tests of proprioception, cerebellar function, and strength (e.g., finger-to-nose testing)
  –Most patients with a positive Romberg's sign will also exhibit abnormal proprioception and vibratory testing
  • Labs may include CBC, electrolytes, glucose, calcium, BUN/creatinine, ESR, vitamin B₁₂ and folate levels, RPR, drug screen, and serum/urine protein electrophoresis
  • EMG/nerve conduction studies testing is the best way to objectively document or exclude a large-fiber, sensory neuropathy
  • MRI is the most effective imaging option if structural spinal cord or cerebellar disease is suspected
  • CSF examination may reveal elevated protein in CIDP or Miller-Fisher variant of GBS; multiple sclerosis patients may have oligoclonal bands or an elevated IgG index

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Romberg's sign: History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))

Once you’ve detected a positive Romberg’s sign, perform other neurologic screening tests. A positive Romberg’s sign only indicates the presence of a defect; it doesn’t pinpoint its cause or location. First, test proprioception. If the patient can’t maintain his balance with his eyes open, ask him to hop on one foot and then on the other. Next, ask him to do a knee bend and to walk a straight line, placing heel to toe. Lastly, ask him to walk a short distance so you can evaluate his gait.

Test the patient’s awareness of body part position by changing the position of one of his fingers, or any other joint, while his eyes are closed. Ask him to describe the change you’ve made.

Next, test the patient’s direction of movement. Ask him to close his eyes and to touch his nose with the index finger of one hand and then with the other. Ask him to repeat this movement several times, gradually increasing his speed. Then test the accuracy of his movement by having him rapidly touch each finger of one hand to the thumb. Next, test sensation in all dermatomes, using a pin to assess sharp/dull differentiation. Also test two-point discrimination by touching two pins (one in each hand) to his skin simultaneously. Does he feel one or two pinpricks? Finally, test and characterize the patient’s deep tendon reflexes (DTRs).

To test the patient’s vibratory sense, ask him to close his eyes; then apply a mildly vibrating tuning fork to a bony prominence such as the medial malleolus. If the patient doesn’t feel the stimulus initially, increase the vibration, and then test the knee or hip. This procedure can also be done to test the fingers, the elbow, and the shoulder.

Record and compare all test results. Ask the patient if he has noticed sensory changes, such as numbness and tingling in his limbs. If so, when did these changes begin?

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Romberg's sign: History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Obtain the patient’s medical history. Ask him about previous neurologic symptoms and disorders. Once you’ve detected a positive Romberg’s sign, perform other neurologic screening tests. Also, ask the patient if he has noticed sensory changes, such as numbness and tingling in his limbs. If so, when did these changes begin?

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Signs of Parry Romberg Syndrome
• Complications of Parry Romberg Syndrome
• Misdiagnosis of Parry Romberg Syndrome
• Misdiagnosis of Underlying Causes of Parry Romberg Syndrome
• Treatments for Parry Romberg Syndrome

Tools & Services:

• Bookmark this page
• Take a survey relating to Parry Romberg Syndrome
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com