"Starry-sky" appearance in Rocky Mountain spotted fever Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

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"Starry-sky" appearance in Rocky Mountain spotted fever Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology

Vignette A 7-year-old previously healthy female presented with high fever, headache, and a diffuse petechial rash. Serology confirmed Rocky Mountain spotted fever, a tick-borne disease caused by Rickettsia rickettsii. The organisms disseminate hematogenously to the CNS and invade arterioles and capillaries, leading to inflammation and disruption of the blood-brain barrier. Kontzialis et al. © 2015 American Academy of Neurology

Kontzialis et al. Imaging © 2015 American Academy of Neurology

Kontzialis et al. "Starry-sky" appearance in Rocky Mountain spotted fever Typical findings on MRI include periventricular and subcortical infarcts secondary to vasculitis, which tend to occur in a perivascular distribution, resulting in a starry sky appearance. Although highly suggestive in the appropriate clinical setting, similar imaging findings have been described in other viral, bacterial, fungal and parasitic infections. 1 © 2015 American Academy of Neurology