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Hydrocephalus and the brain

In this page …

Introducing the brain

Moment to moment the brain needs to take in what is happening in the world around us, our environment, and work out how we should think and act. It needs to do this in any situation we face.

For example, if you are too hot, you take off a jumper. This is quite a simple task but if you hear someone shout “Help!” you know this is a signal that something is wrong. It makes you focus on particular things so that you can make decisions and act in a particular way. Your brain needs to work harder because the task is more complex.

Sometimes even the very simple things can be difficult for someone with hydrocephalus.

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The surface of the brain

The surface of the brain (cerebral cortex) is made up of billions of special cells called neurons. Neurons have fibres that connect one neuron to another (or many others). These fibres allow neurons to ‘communicate’. The cerebral cortex is split into different parts (areas) that do different jobs (or functions).

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Beneath the surface of the brain

Beneath the brain’s surface, the connecting fibres help different areas of the cerebral cortex communicate in different ways. They do this by carrying and routing signals, often in lots of different directions at once.

By sending lots of different signals the brain can ‘switch on’ (activate) or ‘switch off’ (inhibit) parts of the brain and the jobs they do (the functions they perform). Using different parts of our brains in different combinations allows us to think and act in lots of different ways.

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Controlling activity in the brain

To make sure different areas of the brain work together in the right way, there is a type of ‘command centre’ in the front of the brain (the frontal lobes). The frontal lobes are connected to all other areas and structures. This is so that the ‘command centre’ can control when and where signals are sent in the brain. By doing this it ‘activates’ the areas needed to be able to think and act in different situations. Executive functions in the ‘command centre’ work out what is needed. They take charge of other cognitive processes that guide the brain’s functions (e.g. hearing, seeing, remembering, language) when they are needed.

So, when you hear someone shout “Help!” your brain goes through lots of different processes that make you think and act. You are not aware that it’s happening in your brain but it might look a bit like this:

Help diagram

This happens unconsciously and very quickly . . . your brain searches for information so that you can work out what might be happening. It will then come up with different ideas about what you could do: should you call 999 or are you fit and strong enough to chase the robber? In this example your executive functions are directing other cognitive processes so that:

  • You see and hear the things that matter most.
  • You find and use things you already know that help you understand what’s going on.
  • You come up with some ideas about how to act.
  • You hold all of these different bits of information in mind while you make decisions.
  • You come up with a plan and put it into action.

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Why does hydrocephalus make a difference to what happens in the brain?

Hydrocephalus causes swelling and pressure in the brain. This can cause damage to brain cells (neurons), structures and their connections. This means that the brain’s functions or the cognitive processes that guide them may not work the way they are supposed to. Pressure and swelling may also change the frontal ‘command centre’ of the brain or the connections it has with other structures and areas. This may mean that the brain’s executive functions might struggle to work out what thinking or action needs to happen. Or, it may mean they have less control over what happens.

Children with hydrocephalus can have very few or very many difficulties. The number and type of difficulties will be linked to where and how much brain tissue has been affected by the condition. The following pages tell you more about cognition and executive functions. The aim is to show how they are linked to the way people behave in everyday life and why things can be difficult.


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Other things that can affect how we think and behave

The brain’s processing can be affected by many things. These might include: how we’re feeling; likes and dislikes; and changes in the person’s surroundings or environment. Some of these effects might be more obvious in someone with hydrocephalus. They might also worsen any processing difficulties that the child or young person has.

1 Tiredness/fatigue/illness

Being tired or unwell can affect anyone’s thinking abilities. Some people can get on and do something even though they are not at their best but others might find it harder.

When someone is tired or ill, the brain doesn’t necessarily have all the energy it needs to carry out more complicated thinking. This might affect a child or young person with hydrocephalus more than other young people.

2 Physical or mental discomfort/distress

If someone is in pain, upset, stressed or anxious they will be less able to think clearly. Intense feelings can stop thinking from working the way it should. Someone with hydrocephalus may have processing difficulties that can seem more obvious when they are distressed or in pain.

3 Likes/dislikes

We are more likely to find that tasks we enjoy are easier for us. Even if we don’t like doing something (eg going to the dentist), we can understand the reasons for doing it, so we just get on with it. Someone with hydrocephalus may find it difficult to think differently about a situation so can get ‘stuck’ in their reasons for disliking or not wanting to do it.

In the same kind of way, a person with hydrocephalus may start to do something they really like or enjoy (eg talk about their favourite TV programme) at a time when it is inconvenient or annoying. This can get in the way of doing what is actually needed or planned (eg getting on with a classroom activity). See ‘distractions’ below.

4 Beliefs and values

Actions and decisions are influenced by the things that people believe in and value eg a belief that lack of sleep is not good for you; or valuing the time you spend with your family. Often we need to be flexible about when and where we stick to these beliefs and values. For example, we may be willing to bend the rule about ‘getting enough sleep’ because we enjoy a late evening spent with friends.

Weighing up the pros and cons of different choices can be difficult for someone with hydrocephalus. They may have difficulty working out the best thing to do. They might also have difficulty being flexible in their thinking and may stick rigidly to a ‘rule’, for example.

5 Motivation

Motivation is the willingness to do something. This is often linked to enjoyment and wanting something: we are generally more willing to do things we like. It can also be affected by how we feel both physically and emotionally. We are generally more motivated to so things that will:

  • Provide physical pleasure (eg eating).
  • Make us feel happy/be a source of fun or enjoyment (eg. watching TV, seeing friends).
  • Make us feel better, physically or mentally (eg sleeping).

Motivation or willingness to start an activity might also be low when:

  • The activity is new/unknown.
  • This in turn could be a source of stress.
  • Someone is distracted by something eg pain/discomfort, hunger, feeling too cold/hot or noise or other things happening in the environment

6 Distractions

A child or young person with hydrocephalus may have particular difficulty in stopping or inhibiting their reactions and responses to other things. This could be things happening round about them: a television at home; or what others are doing in the classroom, for example. Distractions can also include ‘inner thoughts’ which can take attention away from the task in hand.

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