The puzzle of choline and lipid peak on spectroscopy

Choline and lipid lactate peaks elevated in a number of intracranial space occupying lesions, in endemic area tuberculosis should be considered. Choline peak along with lipid lactate elevation is non-specific and can be seen in a number of other conditions like high-grade gliomas, Metastases, lymphomas and demyelinating disorders. We present a case of 45 year old gentle man known case chest tuberculosis on treatment default presenting with multiple intracranial lesions showing lipid–choline elevation.