The report describes an 88-year-old female patient with atrial fibrillation who was receiving rivaroxaban and developed multiple intracranial hemorrhages approximately 20 days after initiation of therapy. Initial magnetic resonance imaging revealed multiple intracranial nodules with ring enhancement and edema, leading to a misdiagnosis of multiple intracranial metastatic tumors with hemorrhage. After discontinuation of rivaroxaban, the patient did not receive antitumor treatment, only antihypertensive and symptomatic treatment. Dynamic follow-up during the following months showed a gradual reduction of the lesions and their partial disappearance. The case was eventually diagnosed as multiple intracranial cerebral hemorrhages associated with rivaroxaban. The report emphasizes that intracranial hemorrhage caused by rivaroxaban can present as rare multiple nodular lesions, the imaging appearance of which can be easily confused with metastatic tumors. A comprehensive evaluation including treatment history, dynamic monitoring and progression of lesions is essential for correct diagnosis and prevention of overtreatment.