Khodulev Vasily, Kabylka Aleh, Klimko Artsiom
The Functional Diagnostics Department, Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, BLR.
Department of Neurology, Gomel Regional Clinical Hospital, Gomel, BLR.
Cureus. 2023 Feb 21;15(2):e35254. doi: 10.7759/cureus.35254. eCollection 2023 Feb.
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.
尽管临床实践中经常遇到无神经功能缺损的孤立性小腿疼痛（LPP），但其某些方面在文献中仍未得到充分探讨。对于在神经根损伤评估中使用迟发反应，即F波和A波，存在相互矛盾的证据。我们描述了一名29岁女性的病例，她表现为左小腿疼痛。神经学检查仅显示左侧直腿抬高试验阳性。对左侧胫神经在远端和近端刺激点进行的F波研究显示，F波之前存在A波，且A波持续时间延长。一年后，患者报告在乘坐10小时飞机后出现新发左侧腰背痛并放射至臀区。手法治疗后腰背痛和小腿疼痛缓解。之前在F波之前记录到的A波现在不再可检测到。如常规F波研究所示，神经性神经根成分的存在伴有运动纤维的亚临床损伤。本病例报告说明了将F波持续时间和A波的存在纳入临床、神经生理学和神经影像学数据，在确定孤立性LPP中产生疼痛的结构方面的实用性。
