The following medical news items are relevant to diagnosis of Parry Romberg Syndrome:
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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?
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
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, elbow, and shoulder.
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
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