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Vol. 39. Issue 2.
Pages 70-73 (April - June 2013)
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Vol. 39. Issue 2.
Pages 70-73 (April - June 2013)
Caso médico-forense
Schwannoma vestibular y caída mortal en el anciano. Implicaciones médico-legales
Vestibular schwannoma and fatal fall in the elderly. Medico-legal implications
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3702
Verónica Gordo, José L. Cascallana
Corresponding author
joseluis.cascallana@usc.es

Autor para correspondencia.
Servicio de Patología Forense, Instituto de Medicina Legal de Galicia, Subdirección Lugo, Lugo, España
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Las caídas del anciano suponen un problema sanitario en los países desarrollados al ser frecuentes y producir elevadas tasas de mortalidad/morbilidad. Presentamos un caso de caída mortal en un anciano que falleció por politraumatismo tras un desequilibrio que le hizo desplazarse hacia un lado. La autopsia evidenció un nódulo infratentorial que fue diagnosticado como schwannoma cocleovestibular (SCV).

La muerte fue considerada accidental, sin embargo, la presencia de un SCV y el vértigo asociado, pudo participar iniciando o provocando el desequilibrio fatal. Este factor concausal tiene relevancia jurídica aun cuando no se haya dado con certeza absoluta. En este caso, consideramos que el vértigo fue el desencadenante de la caída. El grado de certeza diagnóstica sería de una razonable probabilidad ya que existen varias posibilidades (vértigo versus tropiezo). Este estándar tiene valor como evidencia en los litigios civiles, en particular a la hora de calcular las indemnizaciones.

Palabras clave:
Riesgo de caídas
Anciano y salud pública
Schwannoma vestibular
Certeza diagnóstica médica
Medicina legal
Abstract

Accidental falls among in the elderly are a significant cause of morbidity/mortality in developed countries because of their high prevalence. We report a case of fatal fall of an old man who lost his balance and fell sideways. The autopsy revealed multiple trauma. There was an infratentorial nodule that was diagnosed as cocleovestibular schwannoma (CVS).

Although the death was deemed accidental, the presence of CVS and the associated vertigo could have contributed to the deadly imbalance. This influential factor is relevant from a legal point of view even if its onset remains uncertain. In this case, we believe that vertigo was the initial cause of the fall and there was a reasonable degree of diagnostic certainty since there was a coexistence of several reasonable possibilities (vertigo versus stumble). This standard has probative value in civil trials, particularly in the assessment of the indemnifications.

Keywords:
Risk of falls
Elderly and public health
Vestibular schwannoma
Diagnostic certainty
Legal medicine

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