<prompt> Which of the following is not a diagnostic criteria for declaring brainstem death?Absence of brainstem reflexesA positive apnea testLack of cerebromotor response to pain in all extremitiesAbsence of stretch reflex from all extremities is essential  <response>: Ans. d. Absence of stretch reflex from all extremities is essential Ref: Harrison 19e 442e-2, 1735. 1776, 18e p2252Absence of stretch reflex from all extremities is not a diagnostic criteria for declaring brainstem death.Criteria for Brain Death Brainstem deathThe definition of Brain stem death requires simultaneous demonstration that the patient has irreversibly lost the capacity of consciousness Coma and the capacity to breathe Apnea, both of which are dependent on intact brainstemQ.Clinical assessment of the integrity of Brainstem has two components including assessment of the integrity of brainstem mediated cranial nerve reflexes and the Apnea testQ.Brainstem deathDeep Unresponsive ComaAbsence of all Brainstem Cranial ReflexesComplete Apnea in presence of hypercarbia Absence of Brainstem Respiratory Reflex Patients with brain death show the deepest comaQ possible with total unresponsiveness to all stimuli. No spontaneous movementQ No response to external stimuliQ VerbalDeep pain All reflexes mediated by cranial nerve must be absentQ Absent Pupillary Light reflex CN II, IIIQ Pupils are usually midsized but may be enlarged but they should not be small Absent Corneal Reflex CNV, VII Absent Vestibulocochlear ReflexQ CN III, IV, VI, VIII No eye movement in response to caloric irrigation of ears Absent Oculocephalic Reflex: Absent Dolls eye reflexQ Eyes wilt move with the head No ocular movements on rapid turning of head. Absent Gag ReflexQ CN IX, X Absent Tracheal Cough ReflexQ CN X Absent Central Motor Response to PainQ CN V, VII No response to deep somatic stimulation. No respiratory effort in response to hypercarbia needs to be demonstrated to show that aponea is due to brainstem medullary damageQ Absent respiratory movement during disconnection from the ventilator with the PaCO2 60 mm Hg is required for the test to be validQ. 