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Bài soạn lâm sàng tham khảo từ sách nước ngoài. | The absence of hemispheric function is documented by unreceptivity and unresponsiveness, usually assessed in the setting of painful stimulation; the patient does not rouse, groan, grimace, or withdraw limbs. Purely spinal reflexes may be maintained: deep tendon reflexes, plantar flexion reflex, plantar withdrawal, and tonic neck reflexes. Decorticate or decerebrate posturing is not compatible with the diagnosis. Absence of brain stem function is assessed by region. Lack of midbrain function is documented by the absence of a pupillary light reflex (most easily assessed by viewing the bright light of an ophthalmoscope through its magnifying lens when focused on the iris). Unreactive pupils may be at midposition (as they will be in death) or dilated, as they often are in the setting of a dopamine infusion. Lack of pontine function is documented by the absence of a response to corneal stimulation and the absence of inducible eye movements: no eye movement toward the side of irrigation of the tympanic membrane with 50 mL of ice water. The oculocephalic response (doll's eyes) is always absent in the setting of absent oculovestibular testing. Cessation of medullary function is documented by the apnea test: no ventilatory movements in the setting of maximum CO
