Sympathetic storm is one of the difficulties when managing severe neurological patients. We reported a 73-year-old female patient who underwent selective craniotomy and aneurysm clipping procedure after rupture of posterior circulation aneurysm, who suffered from sympathetic storm after the operation. On the third post-operative day, the patient presented a deterioration in pulse oxygen saturation, accompanied by a large amount of watery sputum. Computerized tomography (CT) revealed cerebellar hemisphere ischemia and interstitial pulmonary edema. When treated with mechanical ventilation, analgesia and sedation, beta receptor blocker application and individualized fluid management, the patient got better and was finally discharged. The experience in this patient suggests that early identification of sympathetic storm and optimal organ support are necessary to achieve a good prognosis. Neurogenic pulmonary edema and neurogenic stress cardiomyopathy are common complications of sympathetic storm. Early diagnosis and effective treatment can shorten the progress, improve prognosis and reduce mortality.
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