{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:36:08Z","timestamp":1785429368128,"version":"3.56.0"},"reference-count":120,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T00:00:00Z","timestamp":1783728000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Victor Babes University of Medicine and Pharmacy Timisoara"},{"id":[{"id":"https:\/\/ror.org\/00afdp487","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: The coexistence of systemic prothrombotic disorders, chronic thromboembolic pulmonary hypertension (CTEPH), chronic hypoxia, and cerebrovascular thrombosis creates complex diagnostic and therapeutic challenges. Case summary: We report the case of a 52-year-old woman with JAK2V617F-positive polycythemia vera, inherited thrombophilic abnormalities, recurrent pulmonary thromboembolism progressing to severe CTEPH, chronic hypoxemia, cerebral venous sinus thrombosis, and right vertebral artery occlusion. Management challenge: The case illustrates persistent thrombotic risk despite anticoagulation, the need for disease-directed cytoreduction, limited access to CTEPH-directed interventional treatment, neurological vulnerability despite preserved brain parenchymal integrity, and the narrow therapeutic margin created by the combined use of anticoagulant, cytoreductive, and pulmonary vasodilator therapy. Particular emphasis is placed on the competing risks of recurrent thrombosis and hemorrhagic complications, especially in the cerebrovascular territory. Conclusion: This case highlights the need for repeated multidisciplinary reassessment in patients with overlapping hematological, pulmonary, and neurological vascular disease. Improved survival in patients with severe multisystemic conditions may increase the clinical relevance of complex presentations requiring coordinated management. Further evidence is needed to support safer, more standardized treatment strategies for patients requiring simultaneous control of thrombosis, pulmonary vascular disease, myeloproliferation, hypoxia, and treatment-related bleeding risk.<\/jats:p>","DOI":"10.3390\/life16071149","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T07:28:27Z","timestamp":1783927707000},"page":"1149","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Polycythemia Vera, Thrombophilia, CTEPH, Cerebral Venous Sinus Thrombosis and Vertebral Artery Occlusion: A Case-Illustrated Narrative Review of Competing Thrombotic and Hemorrhagic Risks"],"prefix":"10.3390","volume":"16","author":[{"given":"Razvan-Adrian","family":"Bertici","sequence":"first","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania"},{"name":"Center for Research and Innovation in Personalized Medicine of Respiratory Diseases, Department of Infectious Diseases, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania"},{"name":"Centre for Cognitive Research in Neuropsychiatric Pathology, Department of Neurosciences, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania"},{"name":"First Department of Neurology, \u201cPius Br\u00eenzeu\u201d Clinical Emergency County Hospital, Liviu Rebreanu Avenue No. 156, 300736 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3921-2518","authenticated-orcid":false,"given":"Amalia","family":"Ridichie","sequence":"additional","affiliation":[{"name":"Analytical Chemistry Division, Faculty of Pharmacy, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania"},{"name":"Advanced Instrumental Screening Center, Faculty of Pharmacy, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9391-0200","authenticated-orcid":false,"given":"Nicoleta Sorina","family":"Bertici","sequence":"additional","affiliation":[{"name":"Center for Research and Innovation in Personalized Medicine of Respiratory Diseases, Department of Infectious Diseases, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania"},{"name":"Pulmonology Division, Department of Infectious Diseases, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania"},{"name":"Second Department of Pulmonology, Clinical Hospital of Infectious Diseases and Pulmonology \u201cVictor Babes\u201d Timisoara, Gheorghe Adam Street No. 13, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7827-818X","authenticated-orcid":false,"given":"Dragos Catalin","family":"Jianu","sequence":"additional","affiliation":[{"name":"Centre for Cognitive Research in Neuropsychiatric Pathology, Department of Neurosciences, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania"},{"name":"First Department of Neurology, \u201cPius Br\u00eenzeu\u201d Clinical Emergency County Hospital, Liviu Rebreanu Avenue No. 156, 300736 Timisoara, Romania"},{"name":"First Division of Neurology, Department of Neurosciences, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6689-5017","authenticated-orcid":false,"given":"Georgiana","family":"Munteanu","sequence":"additional","affiliation":[{"name":"Centre for Cognitive Research in Neuropsychiatric Pathology, Department of Neurosciences, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania"},{"name":"First Department of Neurology, \u201cPius Br\u00eenzeu\u201d Clinical Emergency County Hospital, Liviu Rebreanu Avenue No. 156, 300736 Timisoara, Romania"},{"name":"First Division of Neurology, Department of Neurosciences, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4146-7681","authenticated-orcid":false,"given":"Traian Flavius","family":"Dan","sequence":"additional","affiliation":[{"name":"Centre for Cognitive Research in Neuropsychiatric Pathology, Department of Neurosciences, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania"},{"name":"First Department of Neurology, \u201cPius Br\u00eenzeu\u201d Clinical Emergency County Hospital, Liviu Rebreanu Avenue No. 156, 300736 Timisoara, Romania"},{"name":"First Division of Neurology, Department of Neurosciences, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adelina","family":"Miron","sequence":"additional","affiliation":[{"name":"First Department of Neurology, \u201cPius Br\u00eenzeu\u201d Clinical Emergency County Hospital, Liviu Rebreanu Avenue No. 156, 300736 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lavinia","family":"Mihnea","sequence":"additional","affiliation":[{"name":"First Department of Neurology, \u201cPius Br\u00eenzeu\u201d Clinical Emergency County Hospital, Liviu Rebreanu Avenue No. 156, 300736 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicoleta","family":"Iacob","sequence":"additional","affiliation":[{"name":"Department of Multidetector Computed Tomography and Magnetic Resonance Imaging, Scanexpert, 300627 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9034-5218","authenticated-orcid":false,"given":"Ovidiu","family":"Fira-Mladinescu","sequence":"additional","affiliation":[{"name":"Center for Research and Innovation in Personalized Medicine of Respiratory Diseases, Department of Infectious Diseases, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 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