Brain death is defined as the complete and irreversible cessation of all brain function. For a diagnosis of brain death to be made, several clinical criteria must be met including coma with no brainstem reflexes, no response to any stimuli, no breathing on their own (apnea), and fixed and dilated pupils. The clinical examination is performed by a neurologist and includes tests of eye and body movements, as well as reflexes. The criteria must be met for 6-24 hours and potentially reversible conditions must be ruled out. While confirmatory tests are not required, they may be done to supplement the clinical diagnosis in some cases.

1. YOUSEF ASSI
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2.  Define
 PREREQUISITES
 CLINICAL CRITERIA
Duration of Observation
Other test
CONCLOSION

3. Is a clinical diagnosis which can be made
when there is complete and irreversible
cessation of all brain function.
 Since, it is now technically possible to
sustain cardiac, circulatory respiratory and
other organ function after the brain has
ceased to be alive, a diagnosis of brain
death can be made before the heart beat
stops.

4. The diagnosis of brain death is based
primarily on clinical criteria. A confirmatory
laboratory test may be done to supplement
the clinical diagnosis.

5. The presence of sedative drugs, hypothermia,
shock, or other potentially reversible conditions
that may depress brain function must be excluded
for these clinical criteria to be valid:
 Body temperature must be 32.2 degree (90 degree
F) or higher.
 If barbiturates (are drugs that act as central
nervous system depressants) are present in the
blood, or were used therapeutically for control of
intracranial pressure or seizures, serum levels
should not exceed 1 mg % at the time of the
clinical examination.
 Absence of severe hypotension (shock).

6. The clinical examination should be done
by a neurologist, neurosurgeon, or critical
care attending who is familiar with the
neurological examination and with these
criteria:
 Coma with cerebral unresponsitivity
 Apnea
 Absent brain stem reflexes
 Persistence of condition for 6 to 24 hours

7. The patient should be deeply comatose
with no movements, no withdrawal,
seizures, spontaneously or to noxious
stimulation. There may be spinal cord
reflexes.

8. Apnea, is an no breath, this results in a
lack of air movement into the lungs, and
cause oxygen levels in the blood to drop.

9. Divided into five tests or criteria
• Pupils - should be mid position in size (4
mm) or dilated in the absence of mydriatics
and unreactive to bright light or noxious
stimulation.
•

10. Eye movements - there should be no
spontaneous eye movements, and the
eyes should remain in the neutral position
on testing the occulocephalic and
occulovestibular reflexes. The
occulocephalic response is tested by rapid
rotation of the head to either side. In
eliciting the occulovestibular reflex, 20-30
ml of ice water are instilled into each ear
external auditory

12. Corneal Reflex - No blinking or eye
movement when the cornea is touched
lightly with cotton.
Gag Reflex - No gagging or coughing
when the oropharynx or trachea is
stimulated.

13. Caloric testing

14. The clinical examination may be repeated
after 12-24 hours. When there is a
structural brain damage and the diagnosis
is known with certainty, a shorter period of
observation is adequate if central nervous
system depressant drugs, metabolic and
anoxic causes have been excluded.

15. Although confirmatory tests are not
mandatory in most situations, additional
testing may be necessary for declaring
brain death in patients in whom the results
of specific components of clinical testing
cannot be reliably evaluated.