Again, blood may be effused in any portion of the _brain substance_, constituting true sanguineous apoplexy. Certain parts are much more frequently the seat of these effusions than others. They are more common in the striated bodies or optic thalami—probably from the greater vascularity of those parts—but may be found in the corpora quadrigemina, the pons Varolii, the crura cerebri, or in the cerebral hemispheres, and occasionally in the cerebellum. The symptoms during life will vary according to the location of the effusion; when in the pia mater, or in other words, outside of the brain, paralysis will seldom attend, though the coma may be profound, with relaxation of the muscular system and sometimes convulsions. When the hæmorrhage is in the optic bed or striated body of one side, from the decussation of fibres in the medulla oblongata, paralysis of the opposite side of the body will follow; while if the effusion has taken place in both hemispheres, the palsy will be double-sided, though probably more complete on one side than on the other. Effusions of blood into the corpora quadrigemina, will most frequently be attended with muscular tremblings or convulsions, and probably impaired sight, with some change in the pupil. When in the medulla oblongata, convulsions, followed by palsy, deep coma, and early death; greater fatality attending effusions at this point, probably, than at any other. When the effusion takes place in the cerebellum, the loss of consciousness will be very temporary; there may be relaxation of muscles without palsy or loss of sensibility, and, it is said, frequent vomiting. The _amount_ of blood effused is subject to the greatest variation. Clots may be found as large as a hen’s egg, or smaller than a pea. Indeed, violent apoplectic attacks, ending in death, may occur, where the most careful examination will fail to detect _any_ effused blood, death being the result of extreme congestion of the membranes. On the other hand, the presence of a clot is not necessarily fatal, evidence being abundant that they may be so far reabsorbed as to be followed by at least partial recovery. The following cases will serve to illustrate these several conditions: CASE I.—_Sudden Death from Cerebral Congestion._