Alex Zanardi, the former Formula One driver who became an inspirational Paralympic champion after having both his legs amputated in a motor racing accident almost two decades ago, was fighting for his life on Saturday after a handbike crash with doctors telling reporters: "The neurological damage is serious".
Zanardi suffered serious head injuries with fears for his sight after losing control of his bike and colliding with a truck during a race in Italy on Friday.
The 53-year-old Italian was airlifted to hospital in Siena and underwent three hours of delicate neurosurgery before being placed in an artificial coma.
Zanardi remained "intubated and on artificial respiration" and his "neurological picture remains serious," doctors at the Santa Maria alle Scotte hospital said.
Dr Sabino Scolletta, head of the emergency department, said on Saturday afternoon that Zanardi was in a "stable condition".
"The clinical picture is good overall, even if it remains serious neurologically," said Scolletta, also referring to "eye injuries".
"There could be consequences for his sight. For this reason, we asked our ophthalmologists for thorough advice, but the assessment can only be made in the next few days," he explained.
Neurosurgeon Giuseppe Olivieri, who carried out the operation on Friday night, described Zanardi's condition as "very serious".
"The conditions are stable, but the neurological damage is serious and uncertain, and instability and deterioration may be possible," Olivieri told journalists.
"He arrived with significant crano-facial trauma.
"All the bones of the face are fractured. He also has fractures on both sides of the frontal bone.
"At the moment, we are not talking about his neurological state. This is something that we will see later, when he wakes up and if he wakes up."
"The patient's situation is serious, that is to say that he can also die. In such cases, the improvements are slow, while the worsening can be brutal."
An investigation has been opened into the organisation of the 'Obiettivo tricolore' relay race in Tuscany.
Mario Valentini, coach of the Italian Paracycling national team, said Zanardi lost control of his bike on a hairpin turn and made "two rolls" before hitting an oncoming truck.
The truck driver later underwent tests for alcohol and drugs which were negative, his lawyer said.
- 'Don't give up' -
An icon in Italy, Zanardi's photo made the front pages of the country's three sports newspapers on Saturday, despite the return of Serie A football later in the day after a three-month shutdown.
"Alex's Drama," headlined the Gazzetta dello Sport whose front page was dedicated to the four-time Paralympic champion.
"No Alex, no!" wrote Corriere dello Sport, while Tuttosport headlined: "Alex, Italy!"
Messages of support poured in for the former Grand Prix driver who twice won the CART championship in the United States, before having both his legs amputated following an accident on the Lausitzring track in Germany in 2001.
He went on to win four gold medals on his handbike in the 2012 and 2016 Paralympic Games, and two silver medals, and multiple world championship titles.
Italian Prime Minister Giuseppe Conte wrote on Twitter: "Courage Alex, don't give up. All of Italy is fighting with you."
"I am so anxious and frightened about Alex Zanardi that I'm holding my breath. I am his fan. I am his friend," tweeted former world Formula One champion Mario Andretti.
"Please do what I'm doing and pray pray for this wonderful man."
Former Formula One world champion Fernando Alonso posted an image of Alex on his handbike: "Come on champion," with Brazilian driver Felipe Massa saying: "I pray for you".
"Fight as you know how to do it, Alex. You are a very great man, courage," tweeted in Italian Charles Leclerc who drives for Ferrari.
Zanardi raced for Jordan, Minardi and Lotus in Formula 1 in the early 1990s before switching to the CART championship in the United States where he was series champion in 1997 and 1998.
He returned to F1 with Williams in 1999 before heading back to the CART series.
"Alex is one of life's truly inspirational people and as we all know, a fighter through and through. Stay strong and Forza Alex," his former Williams team wrote on Twitter.