We consider this case an example of neurological manifestations possibly related to COVID-19, characterized by vascular damage predominantly involving microvessels. The absence of pathological confirmation represents a major limitation, but similar MRI patterns [2] and recent pathological correlations seem to support a microangiopathic substrate [8]. Different mechanisms including a systemic procoagulative status and systemic and local inflammatory processes involving the endothelium, most likely via the ACE2 receptor, and eventual immune-mediated vascular injury could be considered [11]. Clinicians should be aware of the possible severe neurological complications in COVID-19 patients and of the role of MRI in their characterization.