It's a good analog and graphics. In my experience, mainly with vestibular patients and cerebellar stroke, the Romberg is not sensitive nor specific for vestibular loss vs cerebellar loss, but more related to how much loss there is in either system. The "block" is not either there or gone. It is damaged a little or a lot. If the block is damaged only a little, Romberg will be negative. If a lot it will be positive.
Thanks for the comment Peter. Very true. Every analogy has its limits within an schematic construct. Always tricky to balance against imparting the main conceptual message with appropriate info to allow for a deductive approach with being too complex. Also how important to interpret Rombergs alongside the rest of the neuro exam.
Do you think that an association of Romberg/bilateral Babinski and Hoffmann signs are due to cytotoxic Cd8 or vitamin b 12/9 deficiency due to over production of Methionine/Homocysteine?
After nearly 5 years in medical school, i finally understand the concept behind this test. Thank you for the analogy, i’m sharing this with anyone who needs to learn about this.
My god, this channel is amazing! Thanks so much for these simple visual explanations :) If you're open to video requests, I'd love to see one on 3rd nerve palsy!
can you please clarify this to me doctor : You said that patient with cerebellar hemispheres ataxia are unstable and sway , but why ?! We know that patient with cerebellar hemisphere ataxia have limb incoordination(like dysmetria) and not truncal incoordianation , so why they will be imbalanced ?! Is that because of dysmetria and adyadochokinesia of lower limb ?? I hope you clarify this for me please
Thank you for your question. Any cerebellar damage (hemispheric or vermis) may cause sway. Patients with cerebellar vermis damage may sway in any direction. Patients with cerebellar hemisphere damage tend to sway towards the affected side. Even standing up and doing nothing requires precise limb co-ordination to maintain standing up. If unilateral Lt cerebellar damage, it is as if the right leg is normal, but left leg is incoordinated to maintain the left lower limb muscles to adopt upright posture, and we need both legs to stand up straight, hence sway regardless of area of cerebellar damage. Hope this helps.
How about walking ? With Cerebellar ataxia patient walk with wide base gait , but how about sensory and vestibular ataxia ? Do they walk normally when eyes are opened ?!
It's a good analog and graphics. In my experience, mainly with vestibular patients and cerebellar stroke, the Romberg is not sensitive nor specific for vestibular loss vs cerebellar loss, but more related to how much loss there is in either system. The "block" is not either there or gone. It is damaged a little or a lot. If the block is damaged only a little, Romberg will be negative. If a lot it will be positive.
Thanks for the comment Peter. Very true. Every analogy has its limits within an schematic construct. Always tricky to balance against imparting the main conceptual message with appropriate info to allow for a deductive approach with being too complex. Also how important to interpret Rombergs alongside the rest of the neuro exam.
Do you think that an association of Romberg/bilateral Babinski and Hoffmann signs are due to cytotoxic Cd8 or vitamin b 12/9 deficiency due to over production of Methionine/Homocysteine?
Best explanation I’ve seen so far for Romberg sign!
Hi Steven, thank you for the kind words :)
After nearly 5 years in medical school, i finally understand the concept behind this test. Thank you for the analogy, i’m sharing this with anyone who needs to learn about this.
Thank you for your kind words Sahana :)
Excellent analogy and best explanation ever
Congratulations !
Thank you for your kind words :)
My god, this channel is amazing! Thanks so much for these simple visual explanations :)
If you're open to video requests, I'd love to see one on 3rd nerve palsy!
Thank you Ariel for your kind words. I do have 3rd nerve palsy on my list of upcoming animations :)
@@NeurologyAnalogy Awesome!!
can you please clarify this to me doctor : You said that patient with cerebellar hemispheres ataxia are unstable and sway , but why ?!
We know that patient with cerebellar hemisphere ataxia have limb incoordination(like dysmetria) and not truncal incoordianation , so why they will be imbalanced ?! Is that because of dysmetria and adyadochokinesia of lower limb ??
I hope you clarify this for me please
Thank you for your question. Any cerebellar damage (hemispheric or vermis) may cause sway. Patients with cerebellar vermis damage may sway in any direction. Patients with cerebellar hemisphere damage tend to sway towards the affected side. Even standing up and doing nothing requires precise limb co-ordination to maintain standing up. If unilateral Lt cerebellar damage, it is as if the right leg is normal, but left leg is incoordinated to maintain the left lower limb muscles to adopt upright posture, and we need both legs to stand up straight, hence sway regardless of area of cerebellar damage. Hope this helps.
@@NeurologyAnalogy Thank you so much DOCTOR 😍
I love these videos!!!
Thank you for the kind words :)
Great video- thank you! Is the rhomburg test not positive for cerebellar ataxia because it is only a test for proprioception and vestibular damage?
Hey there, that is correct. Rombergs is a test of sensory/vestibular ataxia, not cerebellar ataxia
Thank youuuuuuuuuuuuuu
Thank you for your appreciation :)
How about walking ?
With Cerebellar ataxia patient walk with wide base gait , but how about sensory and vestibular ataxia ? Do they walk normally when eyes are opened ?!
This depends on severity - if the sensory/vestibular ataxia is mild, may walk with a narrow gait. If severe, the gait may be wide even with eyes open
@@NeurologyAnalogy
Thank you 🙏🙏🙏
May god bless you