= Solution
\b[There is no single constant anatomical lesion of <epilepsy>.] A sound <autopsy> answer separates an underlying <brain lesion>, changes associated with longstanding <epilepsy>, and the consequences of the final <seizure> or death.
The potentially causal group includes healed traumatic scars, old <cerebral infarctions> or <intracranial haemorrhages>, developmental abnormalities of the <cerebral cortex>, <brain tumours>, and inflammatory or infectious destruction of <brain> <tissue>. Such abnormalities can leave an enduring network capable of generating recurrent <seizures>. Their importance depends on location and the lifetime history; an incidental abnormality is not automatically the cause. A modern acute symptomatic <seizure> during a transient metabolic disturbance should also not automatically be called <epilepsy>.<Seizure Disorders by Merck Manual Professional Edition>[Etiology of Seizure Disorders, structural, infectious and metabolic causes]{ref}
In longstanding cases one may find <atrophy> or scarring of particular <brain> regions. <Hippocampal sclerosis> is an important modern example: loss of <neurons> with <gliosis> in the <hippocampus>, associated especially with temporal-lobe <epilepsy>. Association does not settle whether a particular lesion preceded the first <seizure>, resulted from repeated <seizures>, or shares another cause with them. Conversely, genetically determined disturbances of <neuronal excitability> can produce recurrent <seizures> without a grossly visible destructive lesion.<Epilepsy and Seizures by the National Institute of Neurological Disorders and Stroke>[Causes of epilepsy; Types of epilepsy, temporal lobe epilepsy and hippocampal scarring]{ref}
For the historical question, vascular redness or <congestion> and alterations around the <medulla oblongata> deserve mention as contemporary observations rather than established universal causes. A January 1864 report describes microscopic examination of fourteen longstanding cases, including dilated <blood vessels> and altered nervous material in that region. Its proposed localization of <epilepsy> to the <medulla oblongata> is a historical theory; modern <epilepsy> is not defined by that site or by those vascular appearances.<Report on epilepsy in the Buffalo Medical and Surgical Journal (January 1864)>[Opening discussion of fourteen cases and the medulla oblongata]{ref}
The terminal group includes <cerebral oedema>, <hypoxic-ischaemic brain injury>, and <pulmonary oedema> or <aspiration> in some deaths. <Congestion> is nonspecific and may be terminal; injuries can result from a fall during a <seizure>. None of these alone establishes that <epilepsy> was the original cause. A modern <autopsy> study of sudden deaths in people with <epilepsy> found both structural abnormalities and nonspecific changes; exclusion of another anatomical or toxicological cause remains central to classifying <sudden unexpected death in epilepsy>.<Sudden Unexpected Death in Epilepsy: A Retrospective Autopsy Study of 112 Epileptic Patients>[Results, neuropathological and pulmonary findings; Discussion, exclusion of other causes]{ref}
The appropriate investigation is therefore inspection followed by systematic <histology>, especially of the <cerebral cortex> and <hippocampus> on both sides, interpreted alongside the recorded <seizure> history and examination of other organs. \b[A normal-looking <brain> does not exclude <epilepsy>, and a congested one does not prove it.]
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