This article reviews the proton MR spectroscopy literature regarding brain infarction and inflammatory diseases. We examine the salient findings reported for bacterial abscesses, intracranial tuberculomas, Creutzfeldt-Jakob disease, herpes simplex encephalitis and HIV. These processes demonstrate specific metabolic profiles which may be useful in differential diagnosis. The results reported in the literature support the view that MR spectroscopy can be employed in longitudinal studies to monitor the response to therapy and therefore may lead to individual optimized treatment effectiveness.