Psychiatric manifestation of neurosarcoidosis: a systematic review with pooled descriptive analysis of case reports and case series.

Neurosarcoidosis is a rare inflammatory disease with a heterogeneous presentation. Psychiatric manifestations may precede neurological involvement, but their prevalence, diagnostic pattern, and treatment outcomes remain insufficiently defined. PubMed, Web of Science and Scopus databases were searched on July 8, 2025, to identify all published case reports reporting psychiatric manifestations in patients with sarcoidosis or neurosarcoidosis without language or publication year restriction. All relevant data were extracted based on study characteristics, patient demographics, clinical history, psychiatric and neurological manifestations, diagnostic investigations, treatment modalities, and clinical outcomes. Eighty-nine studies describing 93 patients' cases were included. The mean age was 45.48 ± 14.46 years, with a male predominance (58.1%). 74.2% had systemic sarcoidosis, while 25.8% presented with isolated neurosarcoidosis. Diagnosis was confirmed by histopathology in 84.9% of patients. Psychiatric symptoms preceded neurological manifestations in 78.5% of cases. The most common psychiatric manifestation was cognitive impairment followed by personality changes (88.2%, 65.6% respectively). MRI frequently showed parenchymal lesions (66.7%) and leptomeningeal enhancement (57.7%), while CSF analysis commonly revealed elevated protein (80%) and pleocytosis (71.3%). Corticosteroids were used in (93.5%) of patients, with 58.1% achieving complete remission. Acute psychiatric onset (48.1% vs. 15.4%, p = 0.002) and delirium (70.4% vs. 41.0%, p = 0.013) were observed with higher remission. Isolated neurosarcoidosis (33.3% vs. 16.7%, p = 0.040), parenchymal lesions (59.0% vs. 50.0%, p = 0.034) and basal ganglia involvement (30.8% vs. 16.7%, p = 0.045) were significantly more common among patients who did not achieve complete remission. Systemic sarcoidosis is more frequently linked with higher remission rates due to earlier recognition and less irreversible CNS damage. Neuropsychiatric presentations are heterogeneous, with delirium associated with favorable remission outcomes. Corticosteroids remain the mainstay of therapy. Further prospective studies are needed to phenotype and optimize management strategies. PROSPERO: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251140210 .