A 34-year-old man is evaluated in the clinic due to difficulty walking over the past 2 weeks. His symptoms have resulted in several recent falls, but he has had no head trauma or loss of consciousness. He has never had these symptoms before. The patient is frustrated as he cannot carry out his duties as a mailman. He has a history of crack cocaine use in the distant past but no current illicit drug use. The patient is in a monogamous relationship but previously had numerous sexual partners. The physician asks him to stand with his feet close together, arms to the sides, and eyes closed. This maneuver most likely tests for abnormalities in which of the following?

Question

A 34-year-old man is evaluated in the clinic due to difficulty walking over the past 2 weeks.  His symptoms have resulted in several recent falls, but he has had no head trauma or loss of consciousness.  He has never had these symptoms before.  The patient is frustrated as he cannot carry out his duties as a mailman.  He has a history of crack cocaine use in the distant past but no current illicit drug use.  The patient is in a monogamous relationship but previously had numerous sexual partners.  The physician asks him to stand with his feet close together, arms to the sides, and eyes closed.  This maneuver most likely tests for abnormalities in which of the following?

Quizplus · Accepted Answer

11ec160b_35be_f134_9249_2749ad30eb7f_MD0001_00 The Romberg test is a test of proprioception used to distinguish sensory from cerebellar ataxia. The maneuver is executed by first instructing the patient to stand with the feet close together, arms to the sides, and eyes open. During this time, the patient is observed for unsteadiness. If the patient is unable to maintain this stance easily, some form of ataxia (cerebellar or sensory) is likely present. To differentiate sensory from cerebellar ataxia, the patient is asked to close the eyes while maintaining the aforementioned posture. Removing the visual input forces the patient to rely on input from proprioceptive receptors in the trunk and extremities for posture maintenance. Failure to maintain this posture with the eyes closed is referred to as a positive Romberg sign and indicates sensory ataxia. Sensory ataxia may be caused by defects in the posterior column or peripheral nerves, which are classically caused by tabes dorsalis (syphilis) or vitamin B₁₂ deficiency. Patients who show little or no change in their unsteadiness with their eyes closed (negative Romberg sign) likely have cerebellar ataxia due to impaired motor coordination. Cerebellar function/motor coordination is typically evaluated with rapid alternating movements, finger-to-nose testing, and heel-to-shin testing (Choice C). (Choice A) The parietal association cortex is an area that integrates multisensory (eg, visual, tactile, verbal) information to comprehend events and generate responses. Lesions in the nondominant hemisphere typically cause contralateral neglect, anosognosia (lack of awareness of illness), and constructional apraxia (inability to draw objects). Patients are tested by being asked to draw a clock or bisect a horizontal line. (Choice B) Gait is tested by observing the patient walk casually, in tandem, on the heels, and on the toes. The patient should be assessed for speed, stride length, step height, and arm swing. (Choice D) Muscle strength is tested directly by having the patient press or pull against resistance. Muscle strength is graded on a scale of 0-5 (0=no contraction, 3=contraction able to overcome gravity, 5=normal). Educational objective: The Romberg test is a test of proprioception in which patients are observed for unsteadiness as they stand with their feet close together, arms to the sides, and eyes closed. Failure to maintain this posture indicates sensory ataxia, which may be caused by defects in the posterior column or peripheral nerves (eg, tabes dorsalis, vitamin B₁₂ deficiency). __________ References: Romberg's test. (http://www.ncbi.nlm.nih.gov/pubmed/12867698)

A 34-Year-Old Man Is Evaluated in the Clinic Due to Difficulty