Subjective visual vertical and Romberg's test correlations in hydrocephalus

Abstract.

Objective: Exploration of the subjective visual vertical in pitch and Romberg's test in patients with hydrocephalus. Patients Eleven patients with communicating normal pressure hydrocephalus and six with non-communicating hydrocephalus due to aqueductal stenosis were examined before and after surgical treatment. Methods: The subjective visual vertical was examined with a simple, custom-made articulated rod. The rod was faintly illuminated from within so as to appear floating in space when presented in darkness. The test task was to manually adjust the rod's position in pitch so that it appeared perfectly vertical. Romberg's test was performed under standardized conditions. Results: Patients with a backward movement on Romberg's test showed a deviation of the subjective visual vertical, tilting the upper end of the rod closer to their eyes. Patients moving in other directions tilted the rod in the opposite direction (p < 0.01). The time in which the patients managed Romberg's test with open eyes correlated with the intratest variability of rod placement (r = 0.86, p < 0.001). After surgery, improvements on Romberg's test correlated with a decreased intratest variability of the subjective visual vertical. There were no differences between the two patient groups. Conclusions: Quantitative measurements of the subjective visual vertical in pitch correlate strongly with results of Romberg's test in patients with hydrocephalus.