Introduction Neurological manifestations have been observed in a relevant proportion of patients with COVID-19 [1] with different magnetic resonance imaging (MRI) patterns [2]. We report the case of a patient with severe neurological complications and brain MRI evidence of multiple supratentorial areas of restricted diffusion at diffusion-weighted imaging (DWI), consistent with acute ischemic lesions, and several susceptibility-weighted imaging (SWI) punctate hypointensities, most referable to microbleeds or alternatively microthrombi. Collection and scientific use of the patient’s data were approved by the regional ethics committee (CER Liguria: 173/2020-DB id 10512). Consent to data publication was verbally obtained from the next of kin.