Background: Neurogenic pulmonary edema (NPE) is a rare but life-threatening complication following acute neurological insults, including intracerebral hemorrhage (ICH). It should be suspected in patients who develop acute hypoxia, pink frothy sputum, bilateral crepitations, and difficulty in ventilating despite endotracheal intubation, especially in the absence of preexisting cardiac disease. Case Summary: A previously healthy 9-year-old boy presented with reduced consciousnessand was diagnosed to have spontaneous ICH with intraventricular extension. Shortly after admission, he developed respiratory distress, hypoxia unresponsive to oxygen therapy and pink frothy sputum. Chest auscultation revealed bilateral crepitations and chest X-ray confirmed pulmonary edema. Despite intubation, ventilation was found to be difficult. Neurogenicpulmonary edema was suspected and managed with intravenous frusemide, mechanical ventilation, and inotropic support. Following EVD insertion and supportive care, the patient showed significant neurological and respiratory improvement. Conclusion: This case highlights the need of suspecting possibility of NPE in neurologicallycompromised patients who present with sudden hypoxia, frothy sputum, and ventilatory difficulty following intubation. Early intervention with supportive intensive care can significantly improve outcomes. Clinicians must maintain a high index of suspicion for NPE in similarcontexts, as delays in diagnosis can lead to poor outcome.