Organic and functional nervous diseases; a text-book of neurology . astomosing vessels is extensive. In the ganglia andcapsule it is very imperfect, as the arteries are terminal. Hence thepermanent effect of occlusion is more serious in lesions of the arteriesof the base than in those of the branches in the cortex. If a largevessel in the cortex — e. g., a main branch of a Sylvian artery, or themiddle cerebral trunk itself—is plugged, the area of softening may beextensive. When a vessel is occluded a clot forms within it whichextends backward to the next large branch. In some cases a secondemb
Organic and functional nervous diseases; a text-book of neurology . astomosing vessels is extensive. In the ganglia andcapsule it is very imperfect, as the arteries are terminal. Hence thepermanent effect of occlusion is more serious in lesions of the arteriesof the base than in those of the branches in the cortex. If a largevessel in the cortex — e. g., a main branch of a Sylvian artery, or themiddle cerebral trunk itself—is plugged, the area of softening may beextensive. When a vessel is occluded a clot forms within it whichextends backward to the next large branch. In some cases a secondembolism is produced by a portion of this clot being swept off intothis branch; then a second attack follows the first within twenty-fourhours. This is the explanation of the recurrence of symptoms whichhave apparently subsided on the day after the attack in cases ofembolism. Thus in one of my patients three attacks occurred onthree successive weeks; the first caused paralysis of the arm, thesecond of arm and leg, the third of the entire side and face. Fig. Transverse section of the middle cerebral artery from a case of obliterating endarteritis. Theproliferation of the inner coat and the reduction of the lumen of the vessel are evident. (Spiller.) A serous infiltration and oedema of the brain occurs in the entiredomain of the artery whicli is occluded, within an hour; but this isto some extent relieved when the collateral circulation is hemorrhage or diapedesis of blood cells is also found in theredematous brain. There are some cases of apoplexy in which theonly le-sion found after death is an cedematous state of one are the cases in which a thrombosis of one internal carotid ormiddle cerebral has been followed by a ra})idly fatal termination beforesoftening has been pr<;duced. 478 CEEEBEAL DISEASES OF VASCULAB ORIGIN. The pathological process in cases of embolism in which the embo-lus is of bacterial origin, as in ulcerative en
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