Findings:
There is a 2.7 x 2.2 cm peripherally enhancing lesion centered in the right thalamus, accompanied by severe surrounding vasogenic edema extending into the midbrain, pons, right superior cerebellar peduncle, and in close association with the right facial colliculus. The third ventricle is displaced 9 mm leftward. Mild ventriculomegaly suggests obstructive hydrocephalus from compression of the cerebral aqueduct and foramen of Monroe.

There is also a 7 mm peripherally enhancing lesion in the medial left parieto-occipital region. A potential 2 mm area of abnormal enhancement in the left subinsular white matter may represent an additional lesion. No definite restriction is observed in diffusion-weighted images.

Mild mucoperiosteal thickening of the ethmoid air cells is present.

Impression:
Large right thalamic lesion with ring enhancement, significant vasogenic edema, 8 mm right to left shift of the third ventricle, and mild obstructive hydrocephalus. There is also a left parieto-occipital lesion, and likely a left subinsular lesion. These findings are most consistent with a diagnosis of toxoplasmosis.

Recommendations:
For your training purposes, recommendations are not included in this report.