Incidentally detected neuroglial cyst in the medulla oblongata

Neuroglial cysts are rare, benign, congenital lesions of neuroectodermal origin that are typically located in the cerebral hemispheres or ventricular system. Involvement of the brainstem, particularly the medulla oblongata, is exceedingly uncommon. Herein, we report the case of a 71-year-old woman in whom a medullary cystic lesion was incidentally discovered during spinal magnetic resonance imaging (MRI) performed for evaluation of lower back pain. Brain MRI revealed a well-defined intra-axial cystic lesion in the right paramedian medulla oblongata extending into the upper cervical spinal cord. The lesion showed typical imaging characteristics of a neuroglial cyst: T2 hyperintensity, T1 hypointensity, and no contrast enhancement. The patient remained asymptomatic, and follow-up imaging over a 12-month period demonstrated no interval change in size or signal. Due to the absence of neurological symptoms and radiological progression, we chose conservative management with no intervention. This case highlights the importance of accurate radiological diagnosis and supports observation as an appropriate strategy for incidentally detected, stable neuroglial cysts in the brainstem.