question: BACKGROUND AND PURPOSE: We conducted this study to investigate the prevalence and distribution of cerebral microbleeds and leukoencephalopathy in hospitalized patients with coronavirus disease 2019 (COVID-19) and correlate with clinical, laboratory, and functional outcomes. METHODS: We performed a retrospective chart review of 4131 COVID-19 positive adult patients who were admitted to 3tertiary care hospitals of an academic medical center at the epicenter of the COVID-19 pandemic in New York City from March 1, 2020, to May 10, 2020, to identify patients who had magnetic resonance imaging (MRI) of the brain. We evaluated the MRIs in detail, and identified a subset of patients with leukoencephalopathy and/or cerebral microbleeds. We compared clinical, laboratory, and functional outcomes for these patients to patients who had a brain MRI that did not show these findings. RESULTS: Of 115 patients who had an MRI of the brain performed, 35 (30.4%) patients had leukoencephalopathy and/or cerebral microbleeds. Patients with leukoencephalopathy and/or cerebral microbleeds had neuroimaging performed later during the hospitalization course (27 versus10.6 days; P<0.001), were clinically sicker at the time of brain MRI (median GCS 6 versus14; P<0.001), and had higher peak D-dimer levels (8018±6677 versus3183±3482; P<0.001), lower nadir platelet count (116.9±62.2 versus158.3±76.2; P=0.03), higher peak international normalized ratio (2.2 versus1.57; P<0.001) values when compared withpatients who had a brain MRI that did not show these findings. They required longer ventilator support (34.6 versus9.1 days; P<0.001) and were more likely to have moderate and severe acute respiratory distress syndrome score (88.6% versus23.8%, P<0.001). These patients had longer hospitalizations (42.1 versus20.9 days; P<0.001), overall worse functional status on discharge (mRS 5 versus4; P=0.001), and higher mortality (20% versus9%; P=0.144). CONCLUSIONS: The presence of leukoencephalopathy and/or cerebral microbleeds is associated with a critical illness, increased mortality, and worse functional outcome in patients with COVID-19.