Objective To analyze the clinical features, diagnosis, treatment, and prognosis of solitary medulla oblongata abscess.

Methods From 2014 to 2017, clinical data of 2 patients diagnosed as solitary medulla oblongata abscess were retrospectively analyzed.

Results One patient was female aged 48 years, and the other patient was male aged 39 years. The disease duration of 2 cases ranged from 6 to 10 days. The first symptom was acute dizziness, which may be accompanied by choking (2/2), hoarseness (2/2), or diplopia (1/2). Nervous system examination showed slow or disappeared gag reflex at the affected side (2/2), disorders of shallow sensation disturbances and limb paralysis at the contralateral side (1/2), and positive Romberg's sign (1/2). Low fever occurred during the course of the disease. Computed tomography and magnetic resonance angiography showed no obvious abnormality. Abnormal signal was found in the left medulla oblongata on magnetic resonance imaging, and the edges showed ring reinforcement after enhancement. Cerebrospinal fluid examination showed no significant abnormality. The source of infection was unknown. Given two or more broad-spectrum antibiotic that readily penetrate the blood-brain-barrier, the clinical manifestations and imaging were significantly improved. The patients were followed up with good outcomes.

Conclusions The medulla oblongata is extremely rare with some unknown etiology. Negative bacterial cultures may be associated with limited lesions. The typical images show cystic space-occupying lesions with a smooth inner wall and ring-enhancement. For abscess which is deep or in functional areas, and with smaller diameter or thin wall, intravenous administration of antibiotics is the first choice. Broad-spectrum antibiotics that easily penetrate the blood-brain-barrier should be adjusted according to the changes of patient's clinical symptoms and abscess cavity.