Suspected ruptured medulla oblongata abscess treated conservatively with a favorable outcome: A rare case report from Vietnam.

Brainstem abscess is a rare and serious condition that requires intensive medical treatment whenever a suggestive diagnosis is made. This report presents the conservative treatment of a middle-aged female patient with a suspected ruptured medulla oblongata abscess. The patient reported a 7-day history of headaches and right-sided weakness. Her neurological symptoms gradually worsened, resulting in right hemiplegia, urinary retention, and swallowing difficulties. Brain magnetic resonance imaging confirmed a severe abscess in the medulla oblongata extending to the upper cervical spinal cord. After 8 weeks of antibiotic and steroid treatment, the patient demonstrated considerable improvement, and follow-up contrast-enhanced magnetic resonance imaging revealed a significant reduction in abscess size. Neurological function recovered nearly to normal, with slight right hemiplegia noted at the 6-month follow-up. These findings suggest that conservative treatment may be feasible in carefully selected patients with a suspected ruptured brainstem abscess and may result in a good outcome; however, treatment decisions should remain individualized.