Spectroscopy was done at the rim of the leison and showed elevated cho/cr ratio, however the ratio was not grossly elevated, further prominent lipid/lactate peaks were found and the Cho/NAA ratio was reduced and not increased as one would expect.
This feature confounded the diagnosis of a glioma, tuberculoma can show mildly elevated cho/Cr and shows prominent lipid/lactate peaks. Tumefactive demyelination can have a similar picture as well.