Immunopsychiatry of Infected Ears, Sinuses, Skulls, and Meninges: Mast Cells, Mozart, Van Gogh.

Medical psychiatry acquires more prominence in the biological field by new anatomical insights into the wrappings of the brain: meninges, but also Meningo-Calvarial Channels (MCCs) connecting the former with the bone marrows' also neuronally steered, functions. The skull-bone's meningeal arteries through migrating and orchestrating mast cells within a framework stressing their relations with arteries (Treviranus 2012-21) could explain enigmatic phenomena like migrainous and post-injury Cortical Spreading Depressions (CSD) or the Reversible Cerebral Vasoconstriction Syndrome (RCVS) escalating to "PRES". The skull might be accessed along chronic (para-)infectious paths resulting in Skull Bone Osteomyelitis (SBO) from the ear-nose-throat, dental and other microbiomes. Such paths seem promoted by compromised innate immune defenses: by "Mendelian" susceptibility, and/or acquired anti-INF-γ- or other auto-immunity or various microbial "Trojans" of e. g. meningeal myelo- and lymphocytes. These interact e. g. from the calvarial marrow niches onward. Hereby competing local and "intentional" intruding mast cells - by disturbing (or ingeniously boosting) cortical development and functioning - acquire relevance by interacting with arteries (Treviranus 2018, 2021). This predicts findings in behavior (Fitzpatrick & Morrow 2017) an "aortal" arterial biomechanical foundation of parasympathetic reverse arterio-intramural cerebro-interstitial drainage by CIMURAF/IPAD-2.0 (Treviranus 2018-21). Here the recent physiological re-conceptions of the skull illuminate own case histories through a gamut of possibly relevant neuro(-surgico)-psychiatric challenges. Among these meningo-cerebral immune, vasospastic, and cystic processes some generate broad "experiential" hallucinations, which may slowly transit to true psychoses through "perfect crime lesions" of neurons and glia by tryptase-armed mast cells descending into parenchyma often congested by "push-back". These emerging hypotheses coalesce in advancing an integrative macro-medical psychiatry and even the pathography of Van Gogh and Mozart stressing the benign and creative roles of mast cells.