Objective: This study was conducted to investigate role of MRS in differentiation of intracranial tuberculomas and neurocysticercosis based on metabolite peaks and ratios. Methods: 23 patients (12 cases of tuberculoma and 11 cases of neurocysticercosis) were studied using Single voxel spectroscopy (PRESS technique) with identification of various metabolite peaks and calculation of NAA/Cho, Cho/Cr and NAA/Cr ratios. MRS findings were analyzed independently and subsequently correlated with clinical findings, conventional MRI findings and patient follow up. Results: Elevated choline noted in 75% (9/12) of tuberculomas and  64% (7/11) of  neurocysticercosis respectively (P value 0.67). Lipid peak seen in 67% (8/12) tuberculomas with the sensitivity, specificity, PPV and NPV for tuberculomas of 67%, 91%, 89% and 71% respectively. The lactate peak noted in 45% (5/11) of NCC with the sensitivity, specificity, PPV and NPV of 45%, 100%, 100% and 67% respectively. Elevated Cho/Cr ratio(>1) was noted in 83%(10/12) cases of tuberculomas and 54% (6/11) cases of neurocysticercosis (P value 0.19). Sensitivity for tuberculoma 83%, specificity 45% with PPV 63% and NPV 71%. Conclusions: Presence of lipid peak is more specific for diagnosis of tuberculoma while lactate peak may be helpful for characterisation of neurocysticercosis. Elevated Ch/Cr ratio >1 has high sensitivity for tuberculoma but poor specificity in differentiating from neurocysticercosis.