Penetrating Anterior Skull Base Fracture Inflicted by a Cow's Horn.

Farm workers are at increased risk for animal-inflicted head injuries that are associated with significant morbidity and occasionally may be fatal. These injuries may cause permanent eye damage with or without concomitant skull base fracture. Here, we present a male farmer who suffered a cow attack that resulted in perforating orbital injury with comminuted frontobasal cranial fracture caused by a cow's horn. The next day, the patient developed nasal and orbital cerebrospinal fluid (CSF) leak. Computed Tomography cisternography revealed CSF leakage to frontal and maxillary sinuses. The patient was treated using prophylactic antibiotic therapy, lumbar drainage, and underwent craniotomy for debridement and dural tear plastic. Post operative course was uneventful and there were no signs of CSF leak 1 year after the surgery. The case illustrates unusual injury inflicted by a cow's horn and underscores the importance of careful investigation for underlying skull base fracture and CSF leakage in patients sustaining perforating orbital injuries. Adequate and timely management of dural tears is associated with favorable outcomes.

Noninvasive monitoring of cerebrovascular autoregulation response to resistance exercises.

BACKGROUND AND OBJECTIVE. A novel noninvasive monitor is presented by demonstrating its capabilities to perform the real-time estimation of dynamics in cerebrovascular autoregulation in athletes during their training. The aim was to explore the characteristics of human cerebrovascular autoregulation by performing the monitoring of cerebrovascular autoregulation responses to resistance exercises in healthy volunteer athletes. MATERIAL AND METHODS. Cerebrovascular autoregulation status was monitored in 20 amateur and 20 elite male athletes (weightlifters and bodybuilders) in the supine position at rest during and after the resistance exercises by using a novel noninvasive monitor "Vittamed." Blood pressure and heart rate were also measured noninvasively. During the exercises, the athletes lifted 50 kg and 80% of 1RM (repetition maximum) weights in a dynamic and static manner in separate tests. RESULTS. The cerebrovascular autoregulation reactivity index showed a temporal improvement in the cerebrovascular autoregulation status for almost all sportsmen after the exercises. No disturbances of cerebrovascular autoregulation response occurred in the weightlifters and amateur athletes after the static and dynamic exercises. However, an unstable status of cerebrovascular autoregulation was observed for the elite bodybuilders during the interval of 400 to 600 s after the exercises. CONCLUSIONS. The data of this study demonstrated significant differences in cerebrovascular autoregulation response to the resistance exercises between the elite bodybuilders and other subjects (amateurs and weightlifters) - a temporarily unstable status of cerebrovascular autoregulation was observed in the group of elite bodybuilders. This study also demonstrated the applicability of the noninvasive device for exploring the physiology of cerebrovascular autoregulation mechanism in elite athletes and healthy volunteers.