Severe Paraproteinemic Demyelinating Neuropathy With Impaired Excitability of the Distal Segments of the Peripheral Nerves

Significance of A-waves in Isolated Calf Pain as a Manifestation of Radicular Pain During F-wave Studies: A Case Report

Although isolated lower leg pain (LPP) without neurological deficit is frequently encountered in clinical practice, some of its aspects remain underexplored in the literature. There is contrasting evidence supporting the use of late responses, namely, F-waves and A-waves, in the assessment of nerve root damage. We describe the case of a 29-year-old female who presented with pain in the left calf. Neurological investigations were only significant for a positive straight leg raise test on the left side. F-wave studies of the left tibial nerve at distal and proximal points of stimulation showed the presence of the A-wave preceding the F-wave, the duration of which was prolonged. One year later, the patient reported new-onset left-sided low back pain with radiation to the gluteal area that appeared after a 10-hour airplane flight. Low back and calf pain were resolved with manipulative therapy. A-waves that had been recorded before F-waves were now no longer detectable. The presence of a neuropathic radicular component was accompanied by subclinical damage to motor fibers, as detected by routine F-waves studies. This case report illustrates the utility of integrating F-wave duration and the presence of A-waves into clinical, neurophysiological, and neuroimaging data in determining pain-generating structures in isolated LLP.