Limited pre-contrast set of imaging sequences are sufficient to clearly identify an expansile lesion within the pulvinar of the right thalamus; a finding requiring immediate communication for action (Level I) (white arrows). It is hypointense on sagittal T1-weighted image (A) and has associated hyperintensity on axial T2-weighted FLAIR extending into the adjacent insular-opercular region (B). Even within the confines of the limited set of sequences, neoplastic differential considerations are still able to be favored over acute ischemia as no evidence of restricted diffusion is seen on diffusion-weighted imaging (DWI) sequences; specifically low signal on DWI trace images (C) and elevated diffusivity on Apparent-Diffusion-Coefficient images (not shown). Post-contrast imaging, not initially available to the readers within the limited set of review sequences, demonstrated no abnormal enhancement (D).
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