Diagnostic Pitfalls: Uncovering Brain Tumors Misinterpreted as Cognitive and Psychiatric Conditions

Abstract

Brain tumors, particularly those involving the frontal and temporal lobes, may initially present with psychiatric manifestations such as mood disturbances, personality changes, cognitive impairment, or behavioral abnormalities. These atypical presentations frequently lead to misdiagnosis as primary psychiatric disorders, resulting in delayed diagnosis and treatment. Diagnostic difficulty is further increased by the overlap between psychiatric and neurological symptom profiles, limited access to early neuroimaging or neuropsychiatric assessment, and persistent clinical stigma. We conducted a narrative review of the literature (1990–2025) using PubMed, Embase, PsycINFO and Web of Science, focusing on adult patients initially diagnosed with psychiatric disorders who were later found to have underlying brain tumors. The reviewed evidence indicates that such misdiagnoses are often associated with delayed recognition of neurological disease, missed therapeutic windows, and increased morbidity. Contributing factors include cognitive bias in clinical reasoning, under‐recognition of subtle neurological signs, and systemic limitations in access to diagnostic imaging. Addressing these challenges requires a high index of suspicion in atypical psychiatric presentations, earlier use of neuroimaging, and a multidisciplinary approach integrating neurology, psychiatry, and neurosurgery. Improved clinical awareness, structured assessment pathways, and patient and caregiver education may further reduce diagnostic delays. Overall, early identification of brain tumors presenting with psychiatric symptoms is essential to improve prognosis, prevent irreversible neurological damage, and optimize functional outcomes.