Abstract: In clinical practice, medullary hemorrhage is very rare in intracerebral hemorrhage, and literature often presents it in the form of case reports. Bilateral medial medullary hemorrhage is even rarer. This paper presents a case of an elderly male patient with a long history of hypertension and poorly controlled blood pressure. This time, the patient developed an acute onset of “dizziness, headache accompanied by nausea, vomiting”, and later developed symptoms such as difficulty in swallowing, dysphagia, aphasia, quadriplegia. Cranial CT scan showed a high density area on both sides of the medulla oblongata with a “heart” shape, diagnosed as medullary hemorrhage, and it was considered that this onset is related to hypertension. The full text first introduces the diagnosis and treatment process of the patient, and then discusses the etiology, clinical manifestations, auxiliary examinations, treatment and outcome, aiming to increase clinical experience of clinicians in diagnosis and treatment of this disease.

Key words: Medial medullary hemorrhage; Bilateral medulla oblongata; Brain stem hemorrhage; Intracerebral hemorrhage; Hypertensive intracerebral hemorrhage

摘要： 临床上延髓出血是少见的脑出血类型，在文献中多以个案报道形式呈现，而双侧延髓内侧出血更为少见。本文介绍了1例老年男性患者，既往高血压病史多年，平日血压控制不佳，此次以“头晕、头痛伴恶心、呕吐”急性发病，后出现饮水呛咳、吞咽困难、失语、四肢瘫痪等症状。完善头颅CT提示双侧延髓内侧呈“心”形的高密度灶，明确诊断为延髓出血，并考虑此次发病与高血压有关。本文介绍了该患者的诊治经过，并从病因、临床表现、辅助检查、治疗以及结局等方面加以讨论，以期增加临床医师关于此病的诊治经验。

关键词: 延髓内侧出血; 双侧延髓; 脑干出血; 脑出血; 高血压脑出血