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GPUs are readily available in cloud computing and personal devices, but their use for data processing acceleration has been slowed down by their limited integration with common programming languages such as Python or Java. Moreover, using GPUs to their full capabilities requires expert knowledge of asynchronous programming. In this work, we present a novel GPU run time scheduler for multi-task GPU computations that transparently provides asynchronous execution, space-sharing, and transfer-computation overlap without requiring in advance any information about the program dependency structure. We leverage the GrCUDA polyglot API to integrate our scheduler with multiple high-level languages and provide a platform for fast prototyping and easy GPU acceleration. We validate our work on 6 benchmarks created to evaluate task-parallelism and show an average of 44% speedup against synchronous execution, with no execution time slowdown compared to hand-optimized host code written using the C++ CUDA Graphs API., 10 pages, to be published in 2021 IEEE International Parallel and Distributed Processing Symposium (IPDPS)

Virtualization is the main building block of many architectures and systems from embedded computing to large scale data-centers. Managing efficiently computing resources and their power consumption becomes fundamental to optimize the performance of the workloads running on those systems, however, hardware tools like Intel RAPL can only introduce power caps without considering performance. This paper presents a performance-aware power capping orchestrator for the Xen hypervisor. The tool exploits hybrid power management techniques to minimize power consumption respecting a given SLA, leveraging RAPL and overcoming its limitations. Experimental evaluation shows that the proposed approach guarantees good results for almost all the analyzed benchmarks (e.g. CPU-, memory- and IO-bound).

Objectives: The combination of systemic thrombolysis and mechanical thrombectomy is indicated in patients with ischemic stroke due to a large vessel occlusion (LVO) and these treatments are time-dependent. Rapid identification of patients with suspected LVO also in a prehospital setting could influence the choice of the destination hospital. Aim of this pilot study was to evaluate the predictive role of a new stroke scale for LVO, comparing it to other scores. Patients and Methods: All consecutive patients admitted to our comprehensive stroke center with suspected ischemic stroke were studied with a CT angiography and 5 different stroke scales were applied. The Large ARtery Occlusion (LARIO) stroke scale consists of 5 items including the assessment of facial palsy, language alteration, grip and arm weakness, and the presence of neglect. A Receiving Operating Characteristic curve was evaluated for each stroke scale to explore the level of accuracy in LVO prediction. Results: A total of 145 patients were included in the analysis. LVO was detected in 37.2% of patients. The Area Under Curve of the LARIO score was 0.951 (95%CI: 0.902–0.980), similar to NIHSS and higher than other scales. The cut-off score for best performance of the LARIO stroke scale was higher than 3 (positive predictive value: 77% and negative predictive value: 100%). Conclusion: The LARIO stroke scale is a simple tool, showing high accuracy in detecting LVO, even if with some limitations due to some false positive cases. Its efficacy has to be confirmed in a pre-hospital setting and other centers.

Thrombolysis represents the best therapy for ischemic stroke but the main limitation of its administration is time. The avoidable delay is a concept reflecting the effectiveness of management pathway. For this reason, we projected a study concerning the detection of main delays with following introduction of corrective factors. In this paper we describe the results after these corrections.Consecutive patients admitted for ischemic stroke during a 3-months period to 35 hospitals of a macro-area of Northern Italy were enrolled. Each time of management was registered, identifying three main intervals: pre-hospital, in-hospital and total times. Previous corrective interventions were: 1.increasing of population awareness to use the Emergency Medical Service (EMS); 2.pre-notification of Emergency Department; 3.use of high urgency codes; 4.use of standardised operational algorithm. Statistical analysis was conducted using time-to-event analysis and Cox proportional hazard regression.1084 patients were enrolled. EMS was alerted for 56.3% of subjects, mainly in females and severe strokes (p0.001). Thrombolytic treatment was performed in 4.7% of patients. Median pre-hospital and in-hospital times were 113 and 105min, while total time was 240. High urgency codes at transport contributed to reduce pre-hospital and in-hospital time (p0.05). EMS use and high urgency codes promoted thrombolysis. Treatment within 4.5hours from symptom onset was performed in 14% of patients more than the first phase of study.The implementation of an organizational system based on EMS and concomitant high urgency codes use was effective to reduce avoidable delay and to increase thrombolysis.

INTRODUCTION Significant carotid stenosis is a well-documented risk factor for ischemic stroke. Carotid endarterectomy (CEA) and carotid artery stenting are effective procedures for the prevention of stroke in patients with this disease. However, the occurrence of restenosis could contribute to an increase in the risk of ischemic stroke. CASE REPORT A 79-year-old woman was admitted to the Neurosurgical Department to undergo a CEA because of a progressive stenosis. At the 3-month radiologic follow-up, the examinations showed a carotid restenosis. She was immediately started on a double-antiplatelet therapy. Blood samples revealed high levels of homocysteine and genetic tests showed a homozygous mutation for methylene tetrahydrofolate reductase A1298C polymorphism. Folic acid associated with pyridoxine was added to the treatment. Radiologic follow-ups showed no changes in the stenosis degree. CONCLUSIONS Even if the association between homocysteine and carotid restenosis after CEA is unclear, an initial screening before the surgical procedure could be useful to promptly treat this condition and probably reduce the risk of this complication. In the case of homozygous mutation, the selection of patients and the appropriate therapy could reduce the risk of carotid restenosis.

Background In the last years several studies have investigated the effects of some air pollutants on cardiovascular diseases (CVD), but the results are not conclusive. Aim of this study was to investigate the association between short-term exposure to ambient air pollution and CVD events in a long-term observational period. Methods All CVD events (myocardial infarction — MI and ischemic stroke — IS) which occurred in residents of Como between January 2005 and December 2014 were included. Demographics and main vascular risk factors were registered for each patient. Principal meteorological variables and four ambient particles (O 3 , SO 2 , NO 2 , PM 10 ) were recorded. Statistical analysis was performed using linear regression (GLM) and a generalized additive model (GAM) estimating Poisson distribution and adjusted for the main risk factors and ambient meteorological variables. Results A total of 4110 events were registered with a mild prevalence of MI (51.6%). In GLM analysis we observed a continuative association between CVD events and SO 2 ( p 10 was associated with CVD occurrences at two-day lag time ( p 10 at the same day and at three- and four-day lag time with HRs ranging between 1.025 and 1.039 ( p Conclusions These data confirm a possible association between some ambient air pollutants and CVD events, precisely MI and IS, with different temporal and cumulative effect.

The aims of this study were (i) to evaluate the clinical features of a consecutive series of young patients with ischemic stroke and (ii) to assess the changes in the clinical management of these patients over the study period. All consecutive cases of young adults aged 16 to 44 years, with ischemic stroke, that were admitted between 2000 and 2005 in 10 Italian hospitals were included. We retrospectively identified 324 patients. One or more vascular risk factors were present in 71.5% of the patients. With respect to the diagnostic process, an increase in the frequency of cerebral noninvasive angiographic studies and a decrease in the use of digital subtraction angiography were observed (P<0.001andP=0.03, resp.). Undetermined causes decreased over 5-year period of study (P<0.001). The diagnosis of cardioembolism increased. Thrombolysis was performed for 7.7% of the patients. PFO closure (8%) was the most frequently employed surgical procedure. In conclusion, the clinical care that is given to young patients with ischemic stroke changed over the study period. In particular, we detected an evolution in the diagnostic process and a reduction in the number of undetermined cases.

Background and Purpose— Lombardia GENS is a multicentre prospective study aimed at diagnosing 5 single-gene disorders associated with stroke (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, Fabry disease, MELAS [mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes], hereditary cerebral amyloid angiopathy, and Marfan syndrome) by applying diagnostic algorithms specific for each clinically suspected disease Methods— We enrolled a consecutive series of patients with ischemic or hemorrhagic stroke or transient ischemic attack admitted in stroke units in the Lombardia region participating in the project. Patients were defined as probable when presenting with stroke or transient ischemic attack of unknown etiopathogenic causes, or in the presence of Results— In 209 patients (57.4±14.7 years), the application of the disease-specific algorithm identified 227 patients with possible monogenic disease. Genetic testing identified pathogenic mutations in 7% of these cases. Familial history of stroke was the only significant specific feature that distinguished mutated patients from nonmutated ones. The presence of cerebrovascular risk factors did not exclude a genetic disease. Conclusions— In patients prescreened using a clinical algorithm for monogenic disorders, we identified monogenic causes of events in 7% of patients in comparison to the 1% to 5% prevalence reported in previous series.

A 25-year-old woman was admitted to the emergency room for headache, behavioural change with psychomotor agitation, memory impairment and chewing automatisms. Her medical history was unremarkable. On admission the hematocrit, haemoglobin level, and results of renal and liver function tests were normal. A computed tomographic (CT) scan of the head, obtained without the administration of contrast material, was normal, as was a chest radiograph. On examination, the patient was awake, alert, and oriented with respect to her name and her father but not the place or time; she answered ‘‘yes’’ or ‘‘no’’ to questions but often cried with unintelligible words. The vital signs were normal. There was no nuchal rigidity. An electroencephalographic (EEG) recording showed diffuse background slowing and delta activity with superimposed bursts of rhythmic beta frequency activity on frontal and temporal regions, a pattern known as extreme delta brush (EDB) (Fig. 1a). Over the first 2 days after admission, the patient fluctuated between episodes of normal lucidity and episodes of unresponsiveness and stereotyped movements. These episodes were interpreted as complex seizures and antiepileptic began (levetiracetam 500 mg bid). Magnetic resonance imaging (MRI) of the head was performed after the administration of gadolinium and revealed only mild leptomeningeal enhancement without brain lesion (Fig. 1b). Lumbar puncture was performed and cerebrospinal fluid (CSF) analysis was unremarkable with normal opening pressure (17 cmH2O). Herpes viruses (HSV 1–2, CMV, EBV, VZV), HIV, JCV, West Nile virus, fleboviruses, and enteroviruses were excluded. On the basis of the clinical picture [1] and EEG findings of EDB [2] an anti-N-methyl-D-aspartate (NMDA) receptor encephalitis was suspected. Thus, intravenous methylprednisolone 500 mg daily was started. Noteworthy, 3 days after admission, she suddenly worsened developing comatose state with a Glasgow Coma Scale score of 3 points. At this stage, a CT scan of the brain showed diffuse brain oedema with a radiological pattern of pseudotumor cerebri-like syndrome (Fig. 1c). Surgical monitoring of intracranial pressure (ICP) revealed severe hypertension (110 cmH2O) and a brain angiography showed no intracranial flow. The same day in which the brain death was declared Cryptococcus neoformans was cultured from CSF, blood and urine. Autopsy revealed disseminated neoformans cryptococcosis.

Some current evidences suggest that stroke incidence and mortality may be higher in elevated air pollution areas. Our study examined the hypothesis of a correlation between air pollution level and ischemic stroke admission and in Hospital mortality in an urban population. Data on a total of 759 stroke admissions and 180 deaths have been obtained over a 4-year period (2000-2003). Five air ambient particles have been studied. A general additive model estimating Poisson distribution has been used, adding meteorological variables as covariates. NO(2) and PM(10) were significantly associated with admission and mortality (P value < 0.05) and with estimated RR of 1.039 (95% CI 1.066-1.013) and 1.078 (95% CI 1.104-1.052) for hospital admission at 2- and 4-day lags, respectively. In conclusion, this study suggests an association between short-term outdoor air pollution exposure and ischemic stroke admission and mortality.

Influenza vaccination has been implicated in Guillain Barre Syndrome (GBS) although the evidence for this link is controversial. A case–control study was conducted between October 2010 and May 2011 in seven Italian Regions to explore the relation between influenza vaccination and GBS. The study included 176 GBS incident cases aged ≥18 years from 86 neurological centers. Controls were selected among patients admitted for acute conditions to the Emergency Department of the same hospital as cases. Each control was matched to a case by sex, age, Region and admission date. Two different analyses were conducted: a matched case–control analysis and a self-controlled case series analysis (SCCS). Case–control analysis included 140 cases matched to 308 controls. The adjusted matched odds ratio (OR) for GBS occurrence within 6 weeks after influenza vaccination was 3.8 (95 % CI: 1.3, 10.5). A much stronger association with gastrointestinal infections (OR = 23.8; 95 % CI 7.3, 77.6) and influenza-like illness or upper respiratory tract infections (OR = 11.5; 95 % CI 5.6, 23.5) was highlighted. The SCCS analysis included all 176 GBS cases. Influenza vaccination was associated with GBS, with a relative risk of 2.1 (95 % CI 1.1, 3.9). According to these results the attributable risk in adults ranges from two to five GBS cases per 1,000,000 vaccinations.

Cerebral ischemia is caused by arterial occlusion due to a thrombus or an embolus. Such occlusion induces multiple and concomitant pathophysiological processes that involve bioenergetic failure, acidosis, loss of cell homeostasis, excitotoxicity, and disruption of the blood-brain barrier. All of these mechanisms contribute to neuronal death, mainly via apoptosis or necrosis. The immune system is involved in this process in the early phases after brain injury, which contributes to potential enlargement of the infarct size and involves the penumbra area. Whereas inflammation and the immune system both exert deleterious effects, they also contribute to brain protection by stimulating a preconditioning status and to the concomitant repair of the injured parenchyma. This review describes the main phases of the inflammatory process occurring after arterial cerebral occlusion, with an emphasis on the role of single mediators.

To evaluate in the setting of a stroke unit ward the usefulness of a prolonged (>6 h) video-EEG recording (PVEEG) in identifying non-convulsive status epilepticus (NCSE) in patients with an acute ischemic stroke. Predictors of NCSE were also evaluated. Patients with an acute ischemic stroke, referred to our unit, were included in this prospective observational study. A PVEEG recording was implemented after stroke in all patients during the first week: (a) promptly in those exhibiting a clear or suspected epileptic manifestation; (b) at any time during the routine activity in the remaining patients. After the first week, a standard EEG/PVEEG recording was hooked up only in presence of an evident or suspected epileptic manifestation or as control of a previous epileptic episode. NCSE was identified in 32 of the 889 patients (3.6 %) included in the study. It occurred early (within the first week) in 20/32 (62.5 %) patients and late in the remaining 12. Diagnosis was made on the basis of a specific clinical suspect (n = 19, 59.4 %) or without any suspect (n = 13, 40.6 %). In a multivariate analysis, a significant association of NCSE was observed with NIHSS score, infarct size and large atherothrombotic etiology. NCSE is not a rare event after an acute ischemic stroke and a delayed diagnosis could worsen patient prognosis. Since NCSE can be difficult to be diagnosed only on clinical grounds, implementation of a prompt PVEEG should be kept available in a stroke unit whenever a patient develop signs, although subtle, consistent with NCSE.

The trisomy of the short arm of chromosome 10 is a rare condition. The phenotypic expression of this genetic aberration is characterised by growth and mental retardation with several neurological signs. We report the neurophysiological findings in a newborn affected by 10p chromosome trisomy who developed seizures. Serial EEGs showed a progressive reduction in burst-suppression activity and a slow rhythmic basal activity. At 1 year of age the recording showed for the first time spikes of high amplitude (up to 800 μV) in bilateral frontal regions. These findings could be related to an asymmetrical cerebral maturation in the context of perinatal sufferance and brain malformation due to the genetic aberration.

We report the case of a woman with natalizumab-treated Multiple Sclerosis (MS) that developed progressive multifocal leukoencephalopathy (PML) with atypical MRI features at early onset. This case shows that PML can have variable radiological patterns in natalizumab-treated MS patients thus expanding the possible MRI patterns at onset in these patients.

Purpose To evaluate the efficacy and safety of intravenously administered lacosamide (iv LCM) in post-stroke non convulsive status epilepticus (NCSE) in elderly patients. Methods We enrolled 16 patients (7 M/9 F; 77±7 years of age) with NCSE. iv LCM was used in all the patients as initial treatment (i.e. patients were directly started on LCM) at a loading dose of 400mg over 30min, followed by a mean maintenance dose of 400mg per day. iv LCM was considered as effective in patients who experience no NCSE for 24h following treatment, as evaluated by EEG recording and clinical observation. Results LCM was effective in treating NCSE in eight of the sixteen patients in whom epileptic activity disappeared (7/8) or was significantly reduced (1/8) within 45–60min after administration. None of these patients relapsed in the following 24h. No adverse events were observed. A partial anterior circulation syndrome (PACS) was present in 10 patients while a total anterior circulation syndrome (TACS) in six. Conclusions This pilot study suggests that LCM exhibits safety and efficacy profiles which make it an optimal candidate as a first-choice drug against post-stroke NCSE in elderly patients. A prospective comparative trial is needed to confirm these preliminary data.

Background and Purpose: Early treatment (i.e. thrombolysis) is crucial for a successful care of ischemic stroke. In the management of stroke, two phases are crucial: the pre-hospital and the in-hospital interval. This work investigated factors influencing pre- and in-hospital delay in a large geographic area of Northern Italy. Methods: Enrolled were patients presenting with ischemic stroke in four administrative districts of Northern Italy (Como, Lecco, Sondrio and Varese) over a 4-month period. Pre-hospital time and in-hospital time with single management steps were recorded prospectively. Age, gender, recruiting hospital, EMS transport and triage codes, clinical severity and thrombolytic treatment were also recorded. Univariate and multivariate analysis of factors predicting pre- and in-hospital delay were performed. Results: Median pre-hospital time and in-hospital time were, respectively, 120 min (interquartile range, IQR 62-271) and 150 min (IQR 80-214). Pre-hospital time was halved in patients hospitalized via EMS (p < 0.001) and clinically more severe (p < 0.001). At multivariate analysis, transport code was associated with delay at any time (p < 0.05). Conclusions: EMS use and transport code predicted treatment delay in patients with ischemic stroke. A more intensive use of EMS and high urgency codes could help increase the number of stroke patients treated appropriately.

Stroke is the leading cause of disability in adulthood, and the principal aim of care in cerebrovascular disease is the reduction of this negative outcome and mortality. Several studies demonstrated the efficacy of thrombolytic therapy in ischemic stroke, but up to 80% of cases could not be treated because the diagnostic workup exceeds the time limit. In this article, we described the design of a study conducted in the northern Lombardy, within the district of Sondrio, Lecco, Como, and Varese. The awaited results of this study are reduction of avoidable delay, organization of an operative stroke emergency network, and identification of highly specialized structures. The study schedules education and data registration with implementation and training of acute stroke management algorithms. The use of standardized protocols during prehospital and in-hospital phase can optimize acute stroke pathways. The results of this study could contribute to the assessment of an effective and homogeneous health system to manage acute stroke.

A 21-year-old woman was referred for recurrent (up to 2 times per month) episodes of generalized hyperhidrosis and hypothermia with a core temperature fluctuating between 32 and 35 C, lasting from 2–3 h. During these attacks, the woman sweated profusely and felt faint; her skin was pale and cool and sinus bradycardia (\50 bpm) was observed. At admission, blood chemistry and cell count were unremarkable. Ictal EEGs, ECG Holter, and echocardiography were unremarkable. Brain MRI revealed the total absence of the corpus callosum (Fig. 1b). The patient had normal mental status and did not display facial dysmorphisms. No neurologic or physical abnormalities were noted. Endocrine evaluation of hypothalamic-pituitary axis, thyroid, adrenals, and gonads was unremarkable. Electroencephalograms and lack of response to anticonvulsants (levetiracetam 1,000 mg twice/day) excluded the epileptic origin of the attacks. Her 11-year-old brother suffered from episodes of hypothermia associated with pallor and profuse sweating, lasting for approximately 1 h from the age of 9 years. His axillary body temperature during the episodes was 34.5 C. These episodes recurred up to ten times per month; they occurred randomly and showed a spontaneous recovery. Possible triggering factors were not recognized by parents. On admission, the boy complained of abdominal pain and he was confused and lethargic. Clinical examination during the attack revealed hypothermia with rectal temperatures as low as 31 C. No neurologic or physical abnormalities, including facial dysmorphisms, were noted. Blood chemistry and cell count were unremarkable. Morning cortisol, prolactin, growth hormone, LH, and FSH were also normal. EEG and brain MRI were normal (Fig. 1a). The diagnosis of Shapiro’ syndrome (SS) was, thus, advanced [1]. Based upon previous cases with similar clinical signs as our patient, we started treatment with clonidine [2–4] at the beginning dose of 25 mcg every 8 h. The size of each dose was gradually increased up to 5 days to a total dose of 150 mcg of clonidine every 12 h. The combination of clonidine medication and continuous intravenous fluids reduced the frequency of attacks during the hospital stay. After 7 days, clonidine treatment was gradually discontinued, tapering over a week. Hypotension and/or sedation were not been recognized during the trial with clonidine in this boy (e.g., weight 65 kg). At the present follow-up, the patients complain about sporadic episodes of hyperhidrosis and hypothermia and intravenous fluids are used during prolonged attacks (e.g., [2 h). First described in 1969, SS consists of the triad of spontaneous periodic hypothermia, hyperhidrosis, and agenesis of the corpus callosum (ACC) [1]. This clinical picture can occur at any age and about 50 cases have been reported [1–9]. As originally reported by Shapiro et al. [1], the syndrome has ACC as a hallmark. 1 Since then, at least 3 patients have been described without this anomaly and are generally considered to be a variant of the condition [5, 6, 8]. In our cases, although corpus callosum agenesis V. Belcastro (&) L. Pierguidi M. Arnaboldi Neurology Clinic, Department of Neuroscience, Sant’Anna Hospital, via Ravona, 22100 Como, Italy e-mail: vincenzobelcastro@libero.it

The cystic dilation of ventriculus terminalis (CDVT) is a rare anatomical variant in adulthood. In this report we describe a new case of an adult with multilobed CDVT, causing low-back pain and subjective disturbances in walking. A myelotomy with fenestration of the cyst was performed with a good clinical and radiological outcome.