Occipital lobe abscesses: A systematic review of clinical presentation, etiology, management, and outcomes

Background: Occipital lobe abscesses are uncommon intracranial infections characterized by involvement of the visual cortex and nearby visual pathways. The existing literature is limited to individual case reports and small series, leaving the clinical features, microbiology, management strategies, and outcomes of these abscesses poorly understood. This systematic review aimed to summarize reported cases of occipital lobe abscesses using crude estimates. Methods: A systematic review of the literature was conducted to find published case reports and series on occipital lobe abscesses. Studies were included if they provided patient-level data on demographics, presentation, imaging, microbiology, treatment, and outcomes. Data were collected into a standardized spreadsheet and summarized with basic counts and percentages. The quality and bias risk of the studies were evaluated using the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports. Results: A total of 881 records were identified, with 26 studies included in the final descriptive synthesis. The average age was 46.5 ± 22.1 years, and 19 patients (73.1%) were male. Headache was the most common symptom, seen in 19 cases (73.1%), followed by fever in 16 (61.5%). Visual symptoms were prominent, observed in 14 cases (53.8%), while seizures and altered consciousness occurred in 6 (23.1%) and 9 cases (34.6%), respectively. Bacterial infections were the leading cause, found in 14 cases (53.8%), with fungal pathogens in 6 cases (23.1%) and polymicrobial infections in 2 cases (7.7%). Nocardia species caused 4 cases (15.4%). Single abscesses were reported in 18 cases (69.2%), and multiple lesions in 8 (30.8%). Surgical treatment was performed in 22 cases (84.6%), including aspiration or burr-hole/stereotactic drainage in 14, and craniotomy or open evacuation in 15. Medical-only treatment was used in 4 cases (15.4%). Good recovery was documented in 19 cases (73.1%), with mortality in 4 (15.4%). Residual neurological deficits and persistent visual deficits were noted in 3 (11.5%) and 2 cases (7.7%), respectively. Conclusion: While occipital lobe abscesses are uncommon, they are clinically identifiable infections that often manifest as visual disturbances alongside systemic and intracranial symptoms. Cases reported show varied causes, different microbiological profiles, and a frequent requirement for surgery. Although the prognosis is often positive, mortality and lasting neurological or visual impairments remain significant concerns. Future studies should standardize reporting of visual symptoms, microbiology results, treatment plans, complications, and long-term functional outcomes.