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or a minor sensory change Visual eld testing usually shows slight peripheral constriction with enlargement of the blind spots As vision diminishes, more severe constriction of the elds, with greater nasal or inferior nasal loss, is found Exceptionally, particularly in children, an otherwise typical Bell s palsy may be associated (Chutorian et al) Mentation and alertness are preserved, and the patient seems surprisingly well aside from the headaches, which infrequently becomes severe enough to limit daily activity Examinations by CT and MRI have shown the ventricles to be normal in size or small The sella may be enlarged and lled with CSF ( empty sella, page 577) There is no MRI evidence of change in the water density of the brain As remarked above, most of the patients are overweight young women, often with menstrual irregularities, but the condition also occurs in children or adolescents, in whom there is no clear sex predominance, and in men (Digre and Corbett) We have had experience with several familial instances eg, affecting mother and daughter Practically all of the women with this disease are obese and so are the men, but to a lesser degree (Durcan et al) In obese women without the pseudotumor syndrome, CSF pressure usually does not differ from that of normal persons (Corbett and Mehta) All forms of endocrine and menstrual abnormalities (particularly amenorrhea) as well as the use of oral contraceptives have been postulated as causative factors, but none has been substantiated Pathophysiology The mechanism of increased CSF pressure in the above-described idiopathic form of the disorder has remained elusive, but recent experience is converging on the possibility that there is a functional obstruction to out ow in the venous sinuses Karahalios and colleagues and others have found the cerebral venous pressure to be consistently elevated in pseudotumor cerebri; in half of their patients, there was a venous out ow obstruction demonstrated by venography, often with a pressure gradient across the site These authors proposed that venous hypertension increases the resistance to CSF absorption and is the proximate mechanism underlying pseudotumor Similarly, Farb and colleagues, using sophisticated MRI venography, visualized venous stenosis in 27 of 29 patients with pseudotumor (and in 4 of 59 control subjects) In both the aforementioned studies and others like them, the nature of the obstruction was not clear, but the fact that in some series it was bilateral and focal suggests that the stenosis was not simply the passive result of raised intracranial pressure This issue is not yet resolved, as noted below A related nding in some cases, pointed out to us some time ago by Fishman, is one of partial obstruction of the lateral sinuses by enlarged pacchionian granulations (seen during the venous phase of conventional angiography) It is here that recent evidence has been most provocative The intervention by stenting of a venous sinus at the sites of apparent obstruction has resulted in clinical improvement and a reduction in CSF pressure For example, 5 of 12 patients treated by Higgins and colleagues became asymptomatic, but this was a population selected by the demonstration of a focal gradient in the lateral sinus during venography Karakalios had similar success in several patients What is not clear is how prevalent these partial venous obstructions are and what precisely is their nature (if not simply enlarged granulations) In some series, the latter abnormality has been found in 10 to 25 percent of patients who lack any features of pseudotumor (Leach et al) In an attempt to settle the issue of the venous stenosis as being a secondary effect of raised intracranial pressure, King and colleagues have measured intracranial venous pressure while withdrawing spinal uid from the cervical subarachnoid space in pa-.

To avoid confusion during the migration, make sure everyone in the company knows well beforehand when it is going to occur This boils down to administrative activities mostly and all very critical As you start to move closer to the go live date, make sure all users are aware of the timeline, and give them updates if anything is going to change Also, in terms of planning the migration itself, try to make the reporting shift during a time when the business users have an opportunity to make sure they have everything they need to do their jobs Try to do the migration over a weekend or during a slow time of the period Avoid doing the migration right before a period closing or some other very important or critical activity This will avoid confusion and make everyone proactive in their approach to the migration Another area to be aware of is compatibility issues or accidental migrations Avoiding any additional concerns around these two aspects of the migration is important In one instance, a project that I was involved with was going through a migration and for some reason the customer didn t realize that the new BI 70 system needed all of the functionality of the Java stack to be available and thought that the BI 70 system worked on the same or similar platform as the 3x system did So, there was little or no support for the Java stack issues and concerns The BI portal was not set up appropriately for the migration and to accept the 70 IViews for the reports to be attached to the portal You can avoid all these issues that deal with overall system capabilities by communicating with the client in the planning stage For example, make sure that everyone has the appropriate version of Excel uploaded to their laptops so that there s no problems debugging any issues and you don t have to worry about inconsistencies in the basic Excel versioning Don t look to try and overkill the migration, meaning don t try to migrate all of your WAD templates, Web reports and all queries at once There are very good reasons why you don t migrate some reports such as those that have large amounts of VBA or the business user is fine with what they have 3x version, or the resources needed to deal with all of the fixes required for the migration are not available on a 100 percent basis but can only devote 50 percent of their time to the migration To summarize this section, make sure that you have a very good plan! This is the key to a successful migration Make sure that you keep it simple and make everything as clear as possible to business users Remember, your customers are the business users and management of the corporation, not the IT department Their needs are quite different from an IT person who isn t concerned if they re looking at a list of information or a dynamic report If you phase in the migration, you should be able to build on wins as each phase is rolled out Ensuring that the initial phases are a success is very important so that word gets around how much more flexible and user friendly the newer system is for the business user This will definitely make the remainder of your migration process easier and less stressful.

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