Background: The pathology behind traumatic brain injury (TBI) ranges from shifts in cellular ionic concentrations to permanent structural damage. TBI patients may develop neurogenic pulmonary edema subsequently but it is a poorly understood entity and is often misdiagnosed. Case Report: We present a case of a young female who presented in altered sensorium with a traumatic brain injury.  Shortly after arrival she developed respiratory distress and shock. She was diagnosed as having a neurogenic pulmonary edema and succumbed to her injuries the following day. Conclusion: Neurogenic pulmonary edema is a fatal complication of higher grades of traumatic brain injury. Timely recognition of the symptoms along with appropriate intervention may help improve the outcomes in an otherwise bleak prognosis.