Link- CECT Neck, 01/13/2025

 After the cancelled maxillofacial CT, I asked my primary care doctor for a PET-CT, having read that it can reveal occult lesions. This was only my second meeting with this doctor, and I'm afraid I came off poorly. I was, and am, experiencing increased cognitive impairment. Just after meds in the morning, like now, I can communicate adequately. As the day wears on I become more distracted. 

I was distraught, talking fast, not in control of my emotions. I omitted context and jumped from subject to subject. 

In the visit summary, he noted that I appeared "uncomfortable".

I had suggested that if he didn't feel comfortable ordering a PET-CT on my suspicion of nasopharyngeal carcinoma/lymphoma/adenocarcinoma/chordoma/anything-to-explain-this (and suggest a course of action)... he could order it to investigate early onset dementia! My mother has Alzheimer's, genome sequencing shows I have a predisposition, and my insurance documentation seemed to state that they cover PET-CT to investigate cognitive decline. (I also have two neurocognitive evaluations to back me up).

My memory is good, my recollection/ articulation of it less so. There are details that are there, but just too headachy to focus on. And this is the second post I'm writing today, and I'm losing focus.

In the end he ordered a CECT Neck, and that is what I want to get to. 

I used to posture about uncertainty. OK, I still do. I don't like the appearance of certainty, because the facts on which it's slathered are nevertheless so often wrong. Certainty has zero value unless you know certain facts, and even then, you don't know what you don't know. 

I mistrust the affect of certainty in others-- My favorite people are thoughtful and circumspect, not bloodying the world with Occam's razor (but I don't have that reference quite right, I think)-- and I resist the sense of certainty in myself-- certainty has never made me less wrong or more right; though it's made others more likely to agree with me, which I find problematic.

I don't know what to do with this. I want reassurances, but I need a reason to believe them. 

It is not enough, for example, that the following study was declared "normal".

Study Result

Narrative & Impression

CT NECK WITH CONTRAST HISTORY: Dysphagia COMPARISON: Cervical spine MRI 11/21/2023 TECHNIQUE: Helical CT was performed of the neck after the intravenous administration of 100 mL Omnipaque 300 contrast. Reformatted images were provided in the coronal and sagittal planes. Automated CT dose control used during this exam. FINDINGS: ORBITS: Unremarkable. PARANASAL SINUSES: Trace bilateral ethmoid air cell mucosal thickening. The paranasal sinuses and mastoid air cells are otherwise clear. NASOPHARYNX: Unremarkable. SUPRAHYOID NECK: Unremarkable appearance of the oropharynx, oral cavity, parapharyngeal space, and retropharyngeal space. INFRAHYOID NECK: Unremarkable appearance of the larynx, hypopharynx, and supraglottis. THYROID: Unremarkable. THORACIC INLET: Trace right apical scarring. The lung apices are otherwise clear. The superior mediastinum is unremarkable. LYMPHATICS: No lymphadenopathy. VASCULATURE: Unremarkable. MUSCULOSKELETAL: No aggressive or suspicious osseous lesions. IMPRESSION: No acute findings.

Neck CECT full scrollable study: https://www.dicomlibrary.com?study=1.3.6.1.4.1.44316.6.102.1.20250324191414864.74810614021364879369

My unprofessional impression: 

Axial views seem to show brainstem crowded from the right at foramen magnum (as on most recent MRI):

There is a 1.6 cm circular shape with enhancing rim abutting (and causing mass effect on?) brainstem. 

Coronal view shows no tonsillar herniation https://radiopaedia.org/articles/tonsillar-herniation

Is there sulcal effacement?  

My brain at left, an example of a normal neck CECT from Radiopaedia at right. My sulci are less visible; little in the way of a hypodense border of CSF between the brain and the skull. (I set the window to level 20, width 350).