Neurogenic pulmonary edema (NPE) occurs in association with CNS lesions and in the absence of underlying cardiopulmonary disease. The dramatic increase in intracranial pressure (ICP) that follows aneurysmal rupture appears to trigger a massive autonomic discharge which causes virtually instantaneous circulatory adjustments i.e. NPE. When we anesthetize a cerebral aneurysmal patient combined with NPE, not only is there the risk of hypoxemia due to NPE, but also we have difficulty in managing to control hemodynamics and hypervolemia. As we experienced a cerebral aneurysmal patient combined with NPE, we report this case with a review of the literature.