Single enhancing brain lesions (SELs), mostly as a result of neurocysticercosis or tuberculosis, are a common cause of seizures. Ten patients with SELs caused by neurocysticercosis (n = 6) or tuberculosis (n = 4) were examined by proton magnetic resonance spectroscopy. Tuberculomas had a high peak of lipids, more choline, and less N-acetylaspartate and creatine. The choline/creatine ratio was greater than 1 in all tuberculomas but in none of the cysticerci. Magnetic resonance spectroscopy differentiates SELs caused by cysticercosis or tuberculosis and may avoid brain biopsies or unnecessary antituberculosis treatments.