Clinical exam · Nervous system
Romberg test !
- Maneuver
The patient stands with the feet together and closes the eyes; losing balance means position sense is failing.
Updated 2026-11-01
See it in 3D: Spinal cord · Cerebellum · Dorsal root ganglia · Vestibulocochlear nerve (VIII)
What it is
Standing uses three inputs: vision, the vestibular system and proprioception. The Romberg test removes vision: if balance depends on the eyes because proprioception is failing, the patient sways or falls on closing them. It is positive in sensory ataxia and is not a cerebellar test, because a patient with cerebellar disease is already unsteady with the eyes open.
The anatomy it tests
- Tests proprioception that ascends in the dorsal columns of the cord from the dorsal root ganglion.
- The spinocerebellar tracts and the vestibular system (cranial nerve VIII) also contribute.
- The cerebellum integrates these signals; damage to it causes unsteadiness even with the eyes open.
How to do it
- Explain the test and remove the shoes; the examiner stands beside or behind the patient, very close.
- Ask the patient to stand with the feet together and the arms at the sides or crossed.
- First watch for about 30 seconds with the eyes open.
- Then ask the patient to close the eyes and watch for another 30 to 60 seconds.
- Record whether sway increases, whether the patient steps to avoid falling, or falls.
- A more sensitive variant: standing in tandem (one foot in front of the other) with the eyes closed.
What a positive result means
- Positive: falls or sways clearly more with the eyes closed than open; suggests sensory ataxia.
- Dorsal columns: subacute combined degeneration from B12 deficiency, tabes dorsalis, posterior cord compression.
- Peripheral nerve: diabetic, alcoholic or chemotherapy-related polyneuropathy.
- Falling to the same side with vertigo suggests a vestibular lesion on that side.
- A negative Romberg does not rule out a mild neuropathy.
Usefulness and limits
- Simple and useful at the bedside, but interpretation is subjective.
- Anxiety or fear of falling increases sway without a real lesion.
- It does not replace testing vibration and position sense.
Test yourself
Think of the answer, then tap the question to see it.
What counts as a positive Romberg test?
The patient stays steady with the eyes open but sways a lot or falls on closing them.
Why is the Romberg not a cerebellar test?
A patient with a cerebellar lesion is already unsteady with the eyes open; removing vision changes balance little.
Which vitamin deficiency causes a positive Romberg through dorsal column damage?
Vitamin B12 deficiency, which causes subacute combined degeneration of the cord.
See it in 3D
The structures of Durgical's 3D anatomy where it is found.
Related
- Sensory examination: modalities and dermatomes
- Cerebellar tests: finger–nose, heel–shin and rapid alternating movements
- Abnormal gaits: hemiparetic, parkinsonian, ataxic, steppage, waddling
- Cerebellar syndrome
Related conditions
- Peripheral neuropathy (diabetic and other)
- Megaloblastic anaemia (B12 or folate deficiency)
- Syphilis
- Benign paroxysmal positional vertigo (BPPV)
Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.
Sources: 16.5 The Coordination and Gait Exams (OpenStax, Anatomy and Physiology 2e, 2022); 16.4 The Sensory and Motor Exams (OpenStax, Anatomy and Physiology 2e, 2022); How To Assess Sensation (MSD Manual Professional Edition, 2024).
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Representative model, for educational purposes only.