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In cerebral congestion, or apoplexy, there is suspension, more or less sudden, of the intellectual functions:—The same in syncope.
"The concept of "cerebral congestion" as a cause of apoplexy was first proposed by Morgagni in 1761, and had a profound influence in the treatment of stroke during the next 150 years. It accounted not only for cerebral hemorrhage, but also for lacunes (Dechambre, 1838), état criblé (Durand-Fardel, 1842), depression, maniac outbursts, headaches, coma, and seizures. According to Hammond (1871, 1878), cerebral congestion was "more common... than any other affection of the nervous system." This notion fell into oblivion when an accurate method for bedside determination of blood pressure became available (Riva-Rocci, 1896; Korotkov, 1905) allowing for better understanding of the neurologic complications of arterial hypertension." From: JAMA Neurology, Cerebral Congestion A Vanished Disease; by: Gustavo C. Román, MD, FACP; April 1987. (rch Neurol. 1987;44(4):444-448. doi:10.1001/archneur.1987.00520160074018)
According to this site: The Texas in the Civil War Message Board. By: Jack DuBose on 3/31/2008. What Is “brain congestion” as cause of death? (Jack Danel) there is more than one answer and that it may be is a catch-all phrase. Brain congestion also appears to be related to effects of trauma or infection, and the ensuing cerebral edema (swelling of the brain). The pressure from the swelling also effectively cuts off arterial flow to certain parts of the brain. Same type of ischemic injury, different mechanism, so technically the term "brain congestion" applies. Falls from horses, shots to the head, concussion from explosions, infection (i.e. meningitis or smallpox)--all of those fit the picture and I expect were pretty common causes of death to foot soldiers and mounted officer, alike. For Robert E Lee the cause of death of congestion of the brain seems to refer to what is now known as ischemic stroke.