Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 01 06 1473 1473 Mojtaba Mojtahedzadeh Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran. & Department of Critical Care Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Fatemeh Afra Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. & Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Amir Nasrollahizadeh Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran. Sepide Javankiani Department of General Surgery, Tehran University of Medical Sciences, Tehran, Iran. Roya Saedpanah Dermatology Clinic, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Elahe Shaban Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Atabak Najafi Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran. & Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Amirmahdi Mojtahedzadeh Center For Undergraduate Students Study In Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary. 2025 11 03 2025 11 07 Spontaneous intracerebral hemorrhage (ICH) with intraventricular extension (IVH) is a life-threatening condition associated with high rates of morbidity and mortality. Current management is primarily supportive, with few pharmacologic options available to optimize cerebral perfusion. Milrinone, a phosphodiesterase-3 (PDE-3) inhibitor commonly used in cardiology to boost cardiac output and stabilize hemodynamics, has rarely been explored in neurocritical care. We describe a 70-year-old man with hypertension who experienced a sudden collapse and left-sided paralysis. Imaging revealed a large hemorrhage affecting the right thalamus and basal ganglia with extension into the ventricles. Despite standard interventions, his neurological condition deteriorated. Intravenous milrinone was initiated as a salvage therapy to support mean arterial pressure (MAP) and preserve cerebral perfusion pressure (CPP). Following treatment, his hemodynamics stabilized, intracranial pressure remained controlled, and neurological function improved. At discharge, he had a Glasgow Coma Scale (GCS) of 14, and follow-up imaging confirmed complete resolution of the clot. This case highlights the potential of milrinone to support both systemic and cerebral hemodynamics in patients with ICH/IVH, demonstrating its combined cardiac and neuroprotective effects. To our knowledge, this is among the first documented uses of intravenous milrinone in spontaneous hemorrhagic stroke, suggesting a promising new application for PDE-3 inhibition in critical care beyond traditional cardiology. https://aacc.tums.ac.ir/index.php/aacc/article/view/1473