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The effectiveness of acupuncture in acute stroke remains largely untested and unproved. A randomized, controlled trial was carried out to study the feasibility of acupuncture in combination with conventional supportive treatment for acute stroke patients. A total of 30 patients, aged 46-74, with the onset of symptoms within 36 h were enrolled into the study after appropriate screening. All patients gave informed consent. Basing on the same supportive treatment, patients were randomly assigned to a treatment with or without acupuncture. The procedure and acupoint selection were discussed and decided through several meetings of a group of senior acupuncture doctors in Taiwan. Acupuncture was applied 3 times/week for 4 weeks. During the study period, there were no problems in conducting this trial in terms of patient availability and acceptance, and physician cooperation. A significantly better neurologic outcome was observed in the acupuncture group on day 28 and day 90. The improvement in neurologic status was greatest in patients with a poor neurologic score at baseline. There were no important side effects except for one episode of dizziness related to acupuncture treatment. The data and results of this study will be used as a guideline for planning a full-scale clinical trial, e.g. sample size calculation, method of randomization with stratification of prognostic factors, choosing acupuncture points and technique of acupuncture.

Two cases of surgically proven myxopapollary ependymomas of filum terminale are reported. In both, myelography and metrizamide-enhanced computed tomographic (CT) scans were performed. An intramedullary tumor in the lower thoracic spine, soft-tissue masses in the neural foramina and enlarged bony spinal canal in the lower thoracic and upper lumbar spine were noted in one case and, in the other, an intradural extramedullary tumor at T12-L1 level. Both patients had normal cranial CT scans, and both presented with similar symptoms—low back pain and weakness and paresthesia of leg or legs for up to 3 years' duration. Myelography and metrizamide-enhanced CT scans were performed in order to evaluate disc disease in one patient and spinal stenosis in the other. Ependymoma was an incidental finding, which was then removed by surgical resection. Pathology confirmed the diagnosis.

Seven cases of surgically proven intraspinal synovial cysts are reported. Computed tomographic (CT) scans demonstrated a series of low-density masses adjacent to the facet joints; in three cases, a dense rim indicated a calcified wall on the cyst; in one, the wall was partially calcified; and in three the mass appeared to be filled with gas. In all of these cases, there was severe degenerative facet disease at the same level as the synovial cyst. In six patients, the cysts were unilateral, while one was bilateral; seven cysts were located at the level of L4-L5, and one at L3-L4. We conclude from this study that the intraspinal synovial cyst can be identified reliably by the CT scan.

A 60-year-old female with a ten-month history of acute myelogenous leukemia, now in hematologic remission, presented with severe dizziness, unsteady gait, nausea and vomiting. She had recently received two courses of chemotherapy, including daunorubicin and ARA-C. She was admitted to Brigham and Women's Hospital. Cranial CT (Figs. 1 and 2) showed a high-density mass in the left cerebellar hemisphere, with central lucency and dense peripheral enhancement. There was osteolytic bone destruction of the inner table of occipital bone on both sides, confirmed on plain films and very dense tentorial enhancement as well as obstructive hydrocephalus. A left vertebral angiogram demonstrated a relatively avascular mass in the left cerebellar hemisphere without venous occlusion. Biopsies of the left cerebellar mass and left occipital bone proved to be chloroma. A follow-up cranial CT two months after the completion of radiation therapy (900 rad delivered to the whole brain and 2600 rad to the posterior fossa) showed complete resolution of the posterior fossa lesions.