A case of missile emboli to a major intracranial vessel resulting in fulminant pulmonary edema is reported. A discussion of the etiology of neurogenic pulmonary edema (NPE) is presented. The cause is thought to be a marked increase in pulmonary artery pressure, due to a massive catechol release in the CNS, and possibly secondary to post-capillary sphincteric constriction. Missile emboli to the cerebral arteries should be removed in order to avoid distal embolization and infarction. The case reported appears to represent the first documented case of missile emboli causing NPE.