Neurogenic pulmonary oedema (NPE) is a recognized, serious, relatively uncommon, acute complication of cerebral insults of various types. Despite numerous animal experimental investigations and case reports, the pathological physiology is not yet elucidated. An acute cerebral insult with raised intracranial pressure is accompanied by violent activation of the sympathetic system and increase in the concentrations of circulating catecholamines. Probably, hydrostatic influences and altered capillary permeability both play roles in the pathogenesis. Acute increase in the total vascular surface in the lungs may also be contributory. Treatment includes intubation and positive pressure ventilation, diuretics, infusion of synthetic catecholamines, alpha-receptor blockades and reduction of raised intracranial pressure by hyperventilation and drainage of liquor. The optimal treatment of NPE is not yet established on account of insufficient knowledge of the pathological physiology.