There are substantial clinical and experimental evidences to support the hypothesis that catecholamine surge causes cardiac failure and pulmonary edema after the acute neurological events. A previous healthy 74-year-old man was submitted to an emergency craniotomy for the evacuation of the delayed subdural hemorrhage after a motorcycle accident. After anesthetic induction, profound hypotension and progressive decrease of arterial oxygen tension developed and continued for several hours in spite of fluid loading and inotropic support with dopamine in combination with dobutamine. Electrocardiographic changes and increase of serum cardiac isoenzymes suggesting myocardial infarction were absent. On auscultation, crackles were detected in both lung bases, indicating pulmonary edema. On the basis of the assumption that left ventricular dysfunction was combined with the acute pulmonary edema, with a possible neurogenic component, aggressive management including dobutamine in combination with isosorbide dinitrate was instituted. As a result, these cardio-respiratory complications rapidly resolved without any neurologic sequelae.