Abstract
Brain tumors can present with various psychiatric symptoms, with or without neurological symptoms, an aspect that complicates the clinical picture. However, no systematic description of symptoms that should prompt a neurological investigation has been provided. This review aims to summarize available case reports describing patients with brain tumors showing psychiatric symptoms before brain tumor diagnosis, in order to provide a comprehensive description of these symptoms as well as their potential relationship with delay in the diagnosis. A systematic literature review on case reports of brain tumors and psychiatric symptoms from 1970 to 2020 was conducted on PubMed, Ovid, Psych Info, and MEDLINE. Exclusion criteria comprised tumors not included in the World Health Organization (WHO) Classification 4th edition and cases in which psychiatric symptoms were absent or followed the diagnosis. A total of 165 case reports were analyzed. In a subset of patients with brain tumors, psychiatric symptoms can be the only manifestation or precede focal neurological signs by months or even years. The appearance of focal or generalized neurological symptoms after, rather than along with, psychiatric symptoms was associated with a significant delay in the diagnosis in adults. A timely assessment of psychiatric symptoms might help to improve early diagnosis of brain tumors.
Highlights
Any type of tumor is considered as an insidious hazard of life, but the uncontrolled proliferation and abnormal growth of cells inside the brain—the organ that makes us who we are—creates an extraordinarily potent threat to our being
The diagnosis of the underlying organic brain disorder is complicated by the relative rare incidence of brain tumors, the fact that the brain is relatively silent as regard to pain [26] and that certain types of slowly growing tumors are commonly found at sites likely to cause mental changes early, such as meningiomas involving the frontal lobes [27,28] or gliomas involving the anterior midline structures [29], while neurological signs may appear later
Of the cases had exclusively psychiatric symptoms and 63 cases (38.2%) psychiatric and generalized neurological symptoms without focal neurological symptoms. These findings indicate that brain tumors can occur with psychiatric symptoms only, in the absence of neurological signs, or even in the “retarded” presence of neurological signs, making the diagnosis of brain tumors much more challenging, and there may be a long latent period before the organic pathology is identified
Summary
Any type of tumor is considered as an insidious hazard of life, but the uncontrolled proliferation and abnormal growth of cells inside the brain—the organ that makes us who we are—creates an extraordinarily potent threat to our being. Despite the fact that brain tumors account for a small proportion of all tumors (1.6%). Tumor-related deaths (2.5%) [2], most of these tumors are fatal if they do not receive a timely diagnosis. Even benign tumors can be lethal or at least interfere with brain functions that are essential for daily living. Brain tumors occur in adults and among children. Brain tumors are the most frequent solid tumors in children and the second most frequent type of cancer, after leukemia [4]. Malignant and benign tumors’ diagnosis poses difficulties, and this is reflected in their symptom interval, defined as the period of time elapsed between the onset of symptoms and the diagnosis
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