title: Inhumans

text: At the beginning of the Kree-Skrull War, millions of years ago in Earth time, the alien Kree established a station on the planet Uranus, a strategic position between the Kree and Skrull empires. Through their work at this station, they discovered that sentient life on nearby Earth had genetic potential invested in it by the alien Celestials. Intrigued, the Kree began to experiment on Earth's then-primitive race "Homo sapiens" to produce the genetically advanced Inhuman race. Their goal was apparently twofold—to investigate possible ways of circumventing their own evolutionary stagnation, and to create a powerful mutant race of soldiers for use against the Skrulls. Although their experiments were successful in creating a strain of humanity with extraordinary abilities, the Kree abandoned their experiment because a genetic prophecy had predicted that the experiments would eventually lead to an anomaly who would destroy the Kree Supreme Intelligence.


title: Inhumans

text: Their test subjects, the Inhumans, went on to form a society of their own, which thrived in seclusion from the rest of humanity and developed advanced technology. Experiments with the mutagenic Terrigen Mist (a process known as Terrigenesis) gave them various powers, but caused lasting genetic damage and deformities, which led to a long-term selective breeding program in an attempt to mitigate the effects of these mutations. The Terrigen Mist is a natural mutagen, arising as a vapor from the Terrigen Crystals, which are able to alter Inhuman biology. The Mists were discovered by the Inhuman geneticist Randac approximately 25,000 years ago. He immersed himself in the Mists and gained mental powers comparable to the Eternals. After centuries of eugenics and birth control, the Inhumans managed to mitigate the genetic damage and cultivated a more responsible use of the Terrigen Mists. The practice they developed was to let only genetically perfect specimens undergo the random mutations provoked by the Mists. Their theory was that genetic screening could avoid the risk of hideous and animal mutations in an individual. However, there are examples throughout the Inhumans' canon where an exposed Inhuman became a devolved, sometimes mindless, evolutionarily inferior throw-back. The term Alpha Primitives was coined for these unfortunate outcasts of Inhuman society, who would for centuries become the breeding stock of a slave race. Resentment at this caste system sometimes bubbles up, and the Alpha Primitives have tried to overthrow their rulers in multiple storylines, often as a result of manipulation by a third party.


title: Inhumans

text: Attilan's society and culture are predicated on a conformist belief system that permits individuality as it applies to genetic development and physical and mental ability, but demands rigid conformity in that each member of society is assigned a place within that society according to those abilities following exposure to the Terrigen Mist. Once assigned, no Inhuman, no matter how great or powerful, can change his or her place within this rigid caste system. However, as an exception, a member of the Royal Family, Crystal, married outside the Inhuman race to the mutant Quicksilver.


title: Inhumans

text: The Inhumans are led by their king, Black Bolt, and his Royal Family, consisting of Medusa, Karnak the Shatterer, Gorgon, Triton, Crystal, Maximus the Mad, and the canine Lockjaw. Both Crystal and Medusa have been members of the Fantastic Four; Crystal has been a member of the Avengers as well.


title: Inhumans

text: Black Bolt has guided the Inhumans through some of the most turbulent times in their history, including several attempts by Maximus to usurp the throne, revolts by the worker class (with their eventual emancipation), attacks by human renegades, the kidnapping of Medusa, the destruction and rebuilding of Attilan, and the revelation of the Inhumans' existence to humanity.


title: Inhumans

text: His role as king of the Inhumans has been tumultuous. The first major crisis occurred when he and Medusa conceived a child. Medusa bore the child in defiance of the Genetic Council, who felt that Black Bolt's bloodline was too dangerous to pass on. The Council nonetheless took the child to examine and forbade parental contact. Medusa escaped to Earth with members of the royal family only to be harassed by Maximus. Black Bolt was torn between his love of family and his duty to respect the Genetic Council, and it was only when the Council was revealed to be using his son in a plot against him that he finally turned against the Council. With that, he gave up the crown as king of the Inhumans. For a while, they lived away from Attilan, but returned in times of need.


title: Inhumans

text: The once-secret existence of the race has come to light among the general public as the Inhumans interact more often with many of Earth's superheroes—including the Fantastic Four, the Avengers, and the X-Men—whom they have aided against threats such as Doctor Doom, Ultron 7, Magneto, and Apocalypse. However, no one came to the Inhumans' aid when an army of Portuguese mercenaries attacked Attilan, which was now located on risen Atlantean ruins. This was actually a coup-d'etat orchestrated by Black Bolt's brother Maximus the Mad.


title: Inhumans

text: Inhuman society changed radically when Ronan the Accuser sought to use the Inhumans as an army to disrupt the Shi'ar control of the Kree after their defeat in the . Appearing over the city of Attilan, Ronan seized control in a surprise attack and forced the Inhumans and their king, Black Bolt, to obey, or he would destroy their only home and everyone in it. He also exiled Maximus and the Alpha Primitives to the Negative Zone. During their time in forced servitude, Ronan revealed that the Inhumans had always been intended as weapons in service to the Kree. To this end, much of the genetic attributes that were encoded in them during the original experiments were meant to give them the abilities and appearances of various alien races, the idea being that these Inhuman slaves could be used to infiltrate alien worlds and races to conduct espionage or assassinations to weaken potential conquests. Ronan used the Inhumans to launch attacks on ships and bases, disrupt a treaty between the Shi'ar and Spartax, and manipulate Black Bolt to assassinate Empress Lilandra.


title: Inhumans

text: Eventually, Black Bolt sought to free his people by challenging Ronan to a personal battle. If Ronan won, the Inhumans would continue to serve him. If the king won, the Inhumans would go free. After a terrible battle, Black Bolt won and Ronan, demonstrating that the Kree still had honor, kept his word and left the Inhumans. All was not over, as the Inhumans were not willing to just follow Black Bolt back to Earth. Pressure had been building in the closed society of Attilan since open contact with the outside world had been made. During their enslavement by Ronan, the Inhumans had wished for their freedom, but had developed a sense of pride in their power and a belief in their own destiny. They no longer believed that Black Bolt or the Royal Family was fit to lead them in the new life they wanted, and they exiled the Royal Family from Attilan. The Royal Family returned to Earth to find their destiny. After suffering bigotry while living in the Baxter Building with the Fantastic Four and turning down political asylum from Latveria by Dr. Doom, the royal family returned to Attilan, which was located on the Blue Area of the Moon. The Inhumans attempted to foster better relations with Earth by sending students to the University of Wisconsin.


title: Inhumans

text: In the events of "Son of M", Quicksilver stole the Terrigen Crystals in an attempt to regain his powers and cure the de-powered mutants from M-Day. The theft led to a conflict on Genosha between the re-powered mutants (whose powers came back as too powerful for their own good causing their eventual surrender), the Inhumans, and the U.S. Office of National Emergency. The conflict ended with the O.N.E. confiscating the Terrigen Crystals, an act that incited Black Bolt to verbally declare war on the United States.


title: Inhumans

text: In January 2007, the miniseries "Silent War" began, with Gorgon launching a first strike on New York. Although the Inhumans do manage to recover the crystals, the episode ends with Maximus again taking control of Attilan. The mini series ends on a cliffhanger, with the destruction of Atilian (foreshadowed in Son of M) and Maximus having taken control over the Inhumans using his psychic power, leaving only Luna and Black Bolt (imprisoned in a cell while Luna feigns support for Maximus for her own safety) free from his control and Maximus vowing that the Inhumans will enslave Earth in retaliation for their destruction of Atilian.


title: Inhumans

text: It has been revealed that Black Bolt has been replaced by a Skrull impostor, in a time frame after "Silent War", but before "World War Hulk". The impostor revealed himself to the Illuminati and was killed after a failed attempt to assassinate the heroes.


title: Inhumans

text: The series, along with Planet Hulk and World War Hulk, and subsequent mini-series Secret Invasion outright ignore the events of Silent War, and it's status quo


title: Inhumans

text: Written by "Heroes" writer Joe Pokaski, this story digs into how the Inhuman Royal Family deals with the news that the Black Bolt had been replaced by a Skrull impostor. The Skrulls attack Attilan while Black Bolt is revealed to be a prisoner of the Skrulls, who intend to use his voice as a weapon of mass destruction. The Inhuman Royal Family defeated several Skrull soldiers and took a Skrull ship with the point of taking the war to the Skrulls and save Black Bolt. With some help from the Kree, they rescue Black Bolt and return to Attilan. The story itself ignores the ending of Silent War, with Medusa being under Maximus's mental thrall, Atilan's destruction, and Maximus having seized control over the Inhuman population via his mental powers save for Black Bolt and Luna (who are immune to his telepathy).


title: Inhumans

text: Finally deciding that they will no longer be used and abused by other races, the Inhumans take drastic action to ensure their survival as a race. To that end, they activate a series of long dormant machines beneath the city of Attilan, transforming it into a gigantic starship, powered by Black Bolt's voice. Breaking free from its resting place on the Moon, Attilan enters hyperspace and tracks down the remnants of the Skrull Armada, completely eradicating it. As Attilan enters Shi'ar space, it attracts the attention of three Shi'ar warships, who order them to depart or they will open fire. They too are destroyed without mercy.


title: Inhumans

text: Attilan reaches the planet Hala, destroying the protective shield that guards their weakened empire and enter the planet itself. The Royal Family confronts Ronan the Accuser, who is serving as king. He admitted he felt that he was just holding the spot of ruler for their true king, Black Bolt, but Black Bolt declined the seat of king.


title: Inhumans

text: The T-Bomb has killed Black Bolt, leaving leadership to Queen Medusa. The Inhuman Royal Family struggles to maintain their grip on the Kree Empire. The Alpha Primitives revolt, Maximus tries to take the throne, and the Kree aristocracy revolts, which erodes the Inhumans' rule.


title: Inhumans

text: Back on Earth, the Fantastic Four encounter an interstellar group of Inhumans formed from the Centaurians, the Dire Wraiths, the Kymellians, and the Badoon. These new Inhumans reveal that the Kree experimented on other interstellar races, aside from humans, and used methods other than the Terrigen Mists. The resulting Universal Inhumans have banded together and traveled to Earth in search of Black Bolt, who they believe will lead their collective people in an eventual takeover of Earth. When Black Bolt returned, the Universal Inhumans arrive on Earth's moon where a prophecy revolving around a Midnight King rising from the Inhuman Program and bringing an end to the Kree is revealed. It is this prophecy which was foresaw by the organic super-computer the Supreme Intelligence during the initial stages of the program that lead to its cancellation. The Intelligence ordered Accuser Huran to murder science officer Von-Warr and weaponized biologist Ry-Noor, the scientists responsible for the program, and summon the Accuser Corps to cleanse the experiments on every world that they had seeded. In its haste, however, the Supreme Intelligence failed to download the full data packet from the scientists, and five races of future "Inhumans" escaped the slaughter: the Badoon, the Centaurians, the Dire Wraiths, the Kymellians and early humans. Together they go to Earth to defeat the four Reeds from the Interdimensional Council.


title: Inhumans

text: Meanwhile, the resurrected Supreme Intelligence orders the Kree to launch an attack to destroy the Earth and the Inhumans in a bid to prevent the genetic prophecy from occurring. They are repelled, with the Inhumans in pursuit.


title: Inhumans

text: During the events of "Infinity", Thanos and his forces attack Attilan and offer to spare the city in exchange for a tribute: the deaths of all Inhumans between the ages of 16 and 22. Black Bolt surmises that the offering is a ruse to hide the fact that Thanos actually desires the death of Thane, a half-Inhuman youth Thanos had fathered years earlier. Maximus had Eldrac transport the remaining Inhumans to different locations to keep them from being killed by Thanos. The search for Thane eventually reveals that secret Inhuman tribes have existed on Earth for years and mated with its population, producing a number of seemingly-normal humans who possess dormant Inhuman genes. In response to Thanos' threat, Black Bolt and Maximus evacuate Attilan before destroying it as a show of defiance. The destruction of the city activates the Terrigenisis Bomb, a creation of Maximus, which spreads the Terrigen Mist across the globe and activates special abilities within numerous unsuspecting humans who were Inhuman descendants.


title: Inhumans

text: During the "Inhumanity" storyline, Karnak was left mentally scarred by said events and begun destroying the upper west side of Manhattan, babbling and sobbing uncontrollably. He was taken into custody by the Avengers. In Stark Tower, Karnak explained to the Avengers what happened during their fight with Thanos and what it meant for the Inhumans. When he was questioning himself for the reason for Black Bolt to spread the Terrigen Mists and what would happen next, Karnak had an epiphany in which he finally saw "the fault in all things". He told Medusa who was present during his interrogation that she needed to forget everything she thought she knew, ignore the instincts, and forget the past. Otherwise, all would be lost. Following this revelation in which he stated it was too late for him to unlearn a lifetime of error, Karnak shattered the window from his containment cell and jumped out of Stark Tower, killing himself.


title: Inhumans

text: It was later revealed that there is another Inhuman city called Orollan which is located somewhere in Greenland. The Inhuman Lash is from Orollan as he plans to recruit the Inhuman descendants to work for him. As the months pass, Medusa also begins gathering the Inhuman descendants (called NuHumans by many), and reveals the existence of the Inhumans to the world. Attilan is rebuilt from its remains on the Hudson River, in a city called New Attilan, serving as an independent nation welcoming all Inhumans and open to any who wish to visit.


title: Inhumans

text: Crystal takes a team of Inhumans on the transport vessel called the R.I.V., or Royal Inhumans Vehicle, to follow the Terrigen Cloud and protect any NuHumans. In Australia she finds a skinhead Inhuman with skin-changing powers and a healer named Panacea. Her team visits the hermit kingdom of Sin-Cong to explore why there have been no NuHumans in that country. Her team then investigates mysterious "skypears" that landed around the globe. They investigate a skyspear in China, but are met with suspicion by the Collective Man and the People's Defense Force. The skyspear attacks the Inhumans and the People's Defense Force, temporarily de-powering the Collective Man. Flint, unaware he is de-powered, nearly kills him with a rock attack, which traumatizes Flint. Crystal decides to leave China and travel to Africa with Ana Kravinoff as their guide to find Flint's family in the Chimanimani Mountains of Mozambique, Africa in the hidden Inhuman city of Utolan. Upon their return to Attilan, Panacea empathizes with Gorgon's suffering and heals his paralysis as practice before she tries her abilities on his comatose son.


title: Inhumans

text: The Terrigen Cloud sweeps over Ohio where it transforms two Ohio State University students named Ulysses Cain and Michelle into Inhumans. While Michelle emerged as a red-skinned beast with wings and a tail, Ulysses emerged unchanged but with the ability of precognition. Iron Man later infiltrated New Attilan to claim Ulysses after fighting off Medusa, Crystal, and Karnak. This leads the Inhumans to head to Stark Tower to reclaim Ulysses which leads to the Avengers, the Ultimates, and S.H.I.E.L.D. to get involved. When Ulysses projects his latest vision that shows a rampaging Hulk standing over the corpses of the superheroes, this causes the younger Inhumans present to cry.


title: Inhumans

text: The Beast works with Iso to find a way to counter the Terrigen Cloud as Medusa tells the Inhuman Royal Family to be prepared just in case the X-Men take action against them as the Terrigen Cloud becomes saturated. When the shrinking of the Terrigen Cloud threatens to render Earth inhospitable for mutants, Emma Frost, Magneto, and Storm make plans to destroy the Terrigen Cloud. The Beast heads back to Attilan to speak to the Royal Family, only for Emma Frost to go ahead with the attack. The X-Men take out most of the Inhuman Royal Family and trap them in Limbo. After hearing from Iso about why the X-Men want to destroy the Terrigen Cloud, Medusa is the one who destroys the Terrigen Cloud. Medusa abdicates the throne and gives all leadership duties to Iso, knowing that her people will not understand why she destroyed the remaining Terrigen Cloud. Now free of the burdens of being a queen, Medusa happily reunites with Black Bolt in the Quiet Room.


title: Inhumans

text: Medusa banishes Maximus into an inter-dimensional prison, then with Crystal, Black Bolt, Flint, Gorgon, and Captain Swain are guided by Noh-Varr to the former Kree throne-world of Hala to discover the origins of Terrigen and offer a future to their doomed people. During the trip they learn Maximus and Black Bolt had switched bodies, so Black Bolt was actually banished. To further complicate matters, Medusa runs her hand through her powerful hair only to pull a large clump out with it, forcing her to announce to her crew that she is dying. It is soon apparent that Medusa's decision to destroy the Terrigen Cloud is afflicting her. She did what she had to in order to save the mutant race, but in doing so she had doomed the future of her people. Because Medusa had pressed the button, that act had the consequence of gradually draining the life energies from her. Akin to dying of a broken heart, Medusa had acted to end a cultural heritage that had lasted millennia and her body has essentially chosen to end with it. Her only hope now is to find the secrets of the Terrigen and bring a new source of it back to their people, so she too can be revitalized.


title: Inhumans

text: The Inhumans and Noh-Var discover info on the Primagen which was used by the Progenitors to create the Kree and what the Terrigen derives from. When the Inhumans obtain the Primagen from the Progenitors' World Farm and Gorgon buys his fellow Inhumans time to get away, Maximus takes a sample of the Primagen and has a vision where the Progenitors attack Earth in retaliation for the theft of the Primagen. While on the Astral Plane with Black Bolt, Medusa and Black Bolt agreed to continue as partners and not lovers. When Medusa takes the Primagen, it restores her hair and health while also causing a backlash in the attacking Progenitor to destroy the approaching Progenitors causing the Ordinator-Class Progenitors that saw the attack from the World Farm to spare Earth from their invasion.


title: Inhumans

text: Following their return from the Progenitors' World Farm, members of the former Inhuman Royal Family and their allies settled on the Moon, where Marvel Boy created by using Kree technology from his native universe, a pocket atmosphere that surrounds the Leibnitz crater which was dubbed the Gray Area of the Moon. Inside the crater, Flint used both Moon rock and his own body crystal to built New Arctilan the Inhumans' new base.


title: Inhumans

text: The Kree have initiated a murdering campaign in order to force Black Bolt to join the Kree Empire. This ultimatum causes the deaths of thousands of Inhumans with the word "Join or Die" carved into their bodies which forced Black Bolt to call together the four Queens of the Universal Inhuman tribes to respond to this threat. However, the meeting goes far from as planned, as an Inhuman executioner named Vox, a Super-Inhuman created by the Kree, begins his bloody rampage across the place. When Black Bolt and his Royal Family reached the meeting place, they discover the bodies of Oola Udonta, Aladi Ko Eke, Onomi Whitemane and Goddess Ovoe, with the same three words written in their blood on a banner hanging about their corpses and eventually realized that they fell in to a trap as one of the dead Inhumans was wired with an explosive. While most of Black Bolt's group made it out alive, thanks to Lockjaw, Triton was not so lucky and was killed in the explosion. Black Bolt then sent Lockjaw to New Arctilan to retrieve his brother Maximus. Unbeknownst to them, Vox and his men had already arrived on New Arctilan and began murdering every Inhuman they come across, old or new. Armed with all of the Inhumans’ abilities and no humanity, Vox easily cuts his prey down with his powers or his energy scythe. Even Maximus cannot defeat Vox, as he quickly loses an arm for even making the attempt. Pretty soon, Lockjaw arrived and stood up with Maximus to attempted to stop Vox on their own but things did not go so well and Vox fired an enormous blast, ripping a hole in both of them.


title: Inhumans

text: When Karnak is sent to the Kree to relay a message from Black Bolt to them, the Kree Commander explains how they dispatched Ronan the Accuser as leader of the Kree after Hala was placed in ruin by Mister Knife and have begun to forge a new life. When asked to kneel, Karnak does not. Instead, he does his best to fend off Vox only for the Super-Inhuman to subdue Karnak. As Black Bolt arrives, he walks through the halls of the Kree base speaking every name of the fallen Inhumans, making it a song about death. Eventually, it comes down to just Black Bolt vs. Vox who is holding Karnak as a shield. Black Bolt signs to Karnak to have Vox take him instead. Vox apparently accepts the change as he teleports himself behind Black Bolt. Before Karnak's very eyes, Vox slits Black Bolt's throat.


title: Inhumans

text: The Kree take Black Bolt prisoner and repair the damage done to his throat without using any sedatives or anesthesia to dull the pain which prompted them to think that Black Bolt's great power is gone when he does not scream and therefore the prophecy about the Midnight King is no longer a threat to the Kree. However while being transported, it turns out that he still has his voice, but it is faint. After killing several Kree, Black Bolt secures a firearm and finds Ronan the Accuser alive. However, he is a prisoner of Vox and having been experimented on alongside the Kree soldiers that are loyal to Ronan. Black Bolt learns of this when he sees that Ronan has been converted to a cyborg. At Ronan's request, Black Bolt enables him a mercy killing by whispering "You are forgiven." Elsewhere, Medusa and the surviving Inhuman Royal Family members try to recruit Beta Ray Bill in their fight against Vox and the Kree.


title: Inhumans

text: The Inhuman Royal Family are finally taking the battle to the Kree and arrive just in time to save Black Bolt from Vox. Thanks to the interference of Beta Ray Bill, the Inhuman Royal Family are able to overpower and kill Vox, but not before he is apparently able to kill Crystal. They soon realize to their surprise that Vox was actually Maximus in disguise concluding that the Super-Inhuman is not a person. Instead, it is a program and it is also revealed that the voice power that everyone assumes is vaporizing his targets was actually just teleporting them instead as it was seen after Crystal's apparent death, she has been transported to an unknown place where Kree scientists are experimenting on the Inhuman victims who were supposedly killed. While Lockjaw is not seen, Triton appears to be in some kind of stasis tank alongside Naja, Sterilon, and other unnamed Inhumans. Crystal is now doomed to be the next Vox.


title: Inhumans

text: Meeting up with the Inhuman Royal Family and Beta Ray Bill, Black Bolt is told by Karnak of Vox being a program that transported his "victims" to the Kree. With the Kree planning to turn any captive Inhumans into Vox, Karnak states that not all of them will be rescued. As Black Bolt has one more scream left, Karnak tells him to make it count. Using his sign language, Black Bolt addresses the others on how he has made mistakes in the past and apologizes to them. After holding a moment of silence, Black Bolt orders Gorgon to turn around. The Inhuman ship strikes the Kree's base. Vox then pushes a button to unleash the Vox-controlled Inhumans. As Gorgon and Beta Ray Bill engage the Kree soldiers, Black Bolt, Medusa and Karnak arrive at the laboratory where they find Vox-controlled Inhumans like Crystal and Lockjaw. Using a laser, Black Bolt clears the Vox-controlled Crystal and Lockjaw just because they were in his way. Entering one door, Black Bolt signs "I love you. I'm sorry" before whispering for them to run. As Medusa and Karnak fight the Vox-controlled Crystal and Lockjaw, Black Bolt confronts other Vox-controlled Inhumans like Triton. With what little remained of his power, Black Bolt destroyed the engines responsible for transmitting the Vox program, killing all the Inhumans there and robbing the Kree of their plans. Gorgon and Beta Ray Bill arrive stating that the Kree have fled and see Crystal and Lockjaw still alive, having been freed from the Vox-control when the engines were destroyed. Black Bolt emerges from the room as Medusa orders Lockjaw to take them away from the Kree base. When Crystal asks where they should go, Black Bolt uses his sign language to say "Home." Lockjaw then teleports them away. Beta Ray Bill would later confirm that the Royals were the last of the Inhumans, though there are still a few Inhumans active on Earth.


title: Inhumans

text: Even without using the Terrigen Mist, the Kree modifications, combined with centuries of selective breeding, have given all Inhumans certain advantages. Their average lifespan is 150 years. An Inhuman in good physical condition possesses superhuman attributes, such as superhuman strength, reaction time, speed, and endurance greater than the finest of human athletes. Karnak and other normal Inhumans who are in excellent physical shape can lift one ton and are physically slightly superior to the peak of normal human physical achievement. Exposure to the Terrigen Mist can both enhance and in some cases reduce these physical capabilities. Most Inhumans are used to living in a pollution-free, germ-free environment and have difficulty tolerating Earth's current level of air and water pollution for any length of time.


title: Inhumans

text: The Alpha Primitives are a slave race created by the Inhumans, first appearing in "Fantastic Four" #47 (February 1966). Because of the Inhumans' low population, they created a labor force of hominids bred to be strong, but of limited intelligence. They were also rendered unable to breed, being produced only by cloning. They were used by Maximus the Mad in several schemes, resulting in their being freed from servitude by Black Bolt; they would no longer be cloned and those already made would be allowed to live out their lives in a preserve under the city proper. After some time though it was understood that the Alpha Primitives could not live on their own, and the previous arrangement was reversed.


title: Inhumans

text: The former king of the Inhumans called the Unspoken revealed that the Alpha Primitives are actually humans who have been exposed to gas created from Xerogen Crystals, a substance created by the Kree as a weapon for the Inhumans to use against their human enemies.


title: Inhumans

text: The Bird-People are a genetic offshoot of the Inhumans with bird wings, and in some cases, bat wings.


title: Inhumans

text: The Kree eventually designed a new race of Inhumans that differs greatly from the original called Super-Inhumans. They are believed to be engineered from birth with almost of all of their fellows' Inhuman abilities and none of their problematic humanity. They cannot be swayed or tricked or bought for as they want nothing but their enemies' hearts to stop beating. The only known member of this new race is Vox and the reason is that the Super-Inhuman race is actually a ruse perpetuated by the Kree and Vox is not actually a person; instead, it is a program designed by the Kree which is then imprinted on selected Inhumans that transforms them genetically into a killing machine. When Vox is defeated or killed, another selected Inhuman would be activated and transformed into Vox.


title: Inhumans

text: According to Diamond Comic Distributors, "Inhuman" #1 was the 18th best selling comic book in April 2014. "Inhuman" #2 was the 45th best selling comic book in May 2014.


title: Inhumans

text: According to Diamond Comic Distributors, "Royals" #1 was the 42nd best selling comic book in April 2017. "Royals" #2 was the 79th best selling comic book in April 2017.


title: Inhumans

text: Brandon Guerrero of "ComicsVerse" gave "Royals" #1 a score of 85%, writing, "What would happen if the Inhumans's Royal Family were to go on a epic journey into space? This is the question that Ewing and Meyers try to answer for us. With their suave artwork and intense narrative, we're giving a story that holds up well with the level of power it has to offer." Jesse Schedeen of "IGN" gave "Royals" #1 a grade of 8.4 out of 10, saying, "The Inhumans needed a fresh start every bit as badly as the X-Men. And while the jury is still out as to whether ResurrXion can truly revive the X-Men franchise's prospects, it's immediately worked wonders for the Inhumans. This issue builds nicely on Ewing's work in Inhumans Prime, paving the way for Medusa, Black Bolt and several other big players to leave Earth and venture into space in search of a brighter future for their people. Between The Ultimates and now this series, Ewing clearly thrives when working in a more cosmic-flavored setting. His prose is intelligent and refined, but not in a clinical way that prevents him from really getting to the heart of the Inhuman struggle and Medusa's search for redemption. It's not entirely clear whether Jonboy Meyers' exaggerated style is the ideal fit for such a somber book, but there's no ignoring the energy he brings to every page or the eye-popping quality of his character designs. At this point, it'll be nice just to see Meyers find a more permanent home for a change."


title: Inhumans

text: According to Diamond Comic Distributors, "Inhumans: Judgment Day" #1 was the 120th best selling comic book in January 2018.


title: Inhumans

text: Peyton Hinckle of "ComicsVerse" gave "Inhumans: Judgment Day" #1 a score of 95%, stating, "For Inhumans fans, this issue is a must-read. It pulls together different characters and plot lines in an effort to start the Inhumans on a new chapter. While parts of the plot feel a little rushed, "INHUMANS: JUDGMENT DAY" #1 does an amazing job of reenergizing Medusa and giving readers who love the classic Inhumans cast something to look forward to in future series." Blair Marnell of "IGN" gave "Inhumans: Judgment Day" #1 a grade of 7.5 out of 10, asserting, "It’s going to take a lot to get past the Inhumans’ “we want to be the new X-Men” phase, and the TV series has made them a joke among the general public. That’s probably not going to change for the foreseeable future. But these characters still have the spark that Stan Lee and Jack Kirby gave them so many years ago, and they can be compelling in the right hands. For this one-shot, Al Ewing recaptures some of that alchemy by reuniting Black Bolt and Medusa while letting the other characters step back from the spotlight. And it really works. Visually, the reemergence of Medusa’s full power is a stunning moment from Mike Del Mundo, and the rest of his contribution is solid as well. Kevin Libranda’s segment gives Black Bolt and Medusa’s reunion a dreamlike quality while delivering some of the much-needed emotional beats between them. This one-shot felt like the end of the last few years’ worth of Inhumans stories. The former royal couple can’t simply resume their relationship, but “forward” seems a great note to leave them on."


title: Inhumans

text: The Inhuman origin is retold during the prologue of Earth X and the Royal family is reimagined, with Medusa having a much bolder hairline and Blackbolt with his mouth bolted shut.


title: Inhumans

text: In this alternate reality created by Franklin Richards, the Inhumans are mostly the same. They live on Earth, in Attilan. The biggest difference is the reverence they hold, shown in statues, for Galactus and the multitude of heralds who operate for him simultaneously. The Terrigen Mists are not completely under their control, coming from a crack in the ground. Their ultimate origins are unknown, but Maximus the Mad escapes in the caverns deep beneath the city to locate it. Here, it is discovered their city holds connections to other areas of the world, such as Mole Man's Monster Isle.


title: Inhumans

text: Black Bolt appears as an ally of Black Panther. The other Inhumans were present at the meeting between Black Bolt, Professor X, and Magneto.


title: Inhumans

text: In the original Squadron Supreme universe, Power Princess's people the Utopians are the equivalent of the Inhumans.


title: Inhumans

text: The Inhumans made their debut in the Ultimate Marvel Universe in "Ultimate Fantastic Four Annual" #1 (2005). It begins with two mountain climbers reached the walls of their city, Atillan, in the Himalayas when they are turned back with their memories erased. The Inhumans made themselves known to the Fantastic Four when a member of their royalty, Crystal, fled to New York after being ordered to marry Black Bolt's brother Maximus. Johnny came across Crystal and attempted to save her from two royal guards from Atillan who were trying to capture her. Beaten, Crystal took him back to the Baxter Building, and revealed herself to the Fantastic Four. She left behind her dog Lockjaw, who had the ability to teleport the Fantastic Four to Atillan. Once their presence was discovered, the city was stripped of its advanced technology and destroyed by Black Bolt, and the Inhumans, including Crystal, relocated. They are hinted to have relocated to the Moon.


title: Inhumans

text: The Ultimate Marvel version of Attilan is quite different in appearance from the Marvel Universe version, like a giant wasp's nest crossed with a Gothic cathedral. Ultimate Crystal, Lockjaw, and Black Bolt are similar to their counterparts; Medusa is depicted as having actual snakes for hair, like her mythical namesake. Gorgon is female, Karnak projects energy blasts (though he can still sense weaknesses and pressure points), Triton has a more squid-like appearance, and Maximus is a somewhat effete courtier, whom Crystal describes as "preening" and a "peacock". Other Inhumans shown include Tri-clops, with clairvoyant vision (including the power to see the invisible), Densitor (Maximus' flunky, who can presumably increase his strength, durability and mass, enough to become fireproof) and an unnamed Inhuman who can produce a swarm of insect-like flying creatures from his body. They claimed that their city had remained secret for 10,000 years, which makes their ancestors contemporaries with Ultimate Marvel's Atlantis.


title: Inhumans

text: The Un-People are a superhero group in the Amalgam Comics universe. They are a combination of DC Comics' Forever People and Marvel Comics' Inhumans.


title: Inhumans

text: In the 2004 Marvel Knights "Inhumans 2099" one-shot written by Robert Kirkman, which took place in the future on an alternate world (Earth-2992) that was not identical to the alternate Marvel Universe on Earth-928 featured in the 1990s Marvel 2099 books, the Inhumans leave Earth's moon and are forced to live aboard a spaceship after the Mutant Registration Act is passed. After leaving, Black Bolt places himself and his closest confidants (Triton, Gorgon, Karnak, Crystal, and Medusa) in cryogenic stasis and, in his absence, his brother Maximus takes over as leader of the Inhumans living aboard the spacecraft. While in control, Maximus kills Black Bolt's confidants in their sleep. Fifty years later, Black Bolt is released from cryogenic stasis to find that Maximus has killed those closest to him. In retaliation, he breaks his vow of silence and destroys the Inhumans' spacecraft, killing all aboard, including himself.


title: Inhumans

text: In this reality Attilan was returned to the Himalayan mountains at some point until the population grew tired of living in seclusion and decided to leave the Great Refuge to forge new destinies among humanity. This happened at a time when Maximus was once more vying for power and had built a bomb that - once detonated - would release the Terrigen Mists into the Earth's atmosphere. The Inhuman Royal Family managed to stop him from doing so with Medusa killing him in the process. With no kingdom to rule over, the Inhuman Royal Family decided to travel to the stars and find their fate elsewhere in the universe. However, Black Bolt felt that his people would be persecuted and demonized by humanity, much like they treat mutants on the outside world, so he decided to unleash the Terrigen Mist bomb filling Earth's atmosphere with the gas. This was unknown to all, including the Watcher, whom Black Bolt had blinded to prevent him from seeing. It has been suggested that Black Bolt had some intimate knowledge about the Celestials' plans for the Earth, and releasing the Terrigen Mists on the Earth was a way to set plans in motion to stop the Celestial birth in Earth's core.


title: BMW M54

text: The BMW M54 is a naturally aspirated straight-6 petrol engine produced from 2000 to 2006. It was released in the E53 X5 and is the replacement for the M52 engine. The S54 is the equivalent high performance engine, used in the E46 M3, the Z3 M Coupé/Roadster and the E85/E86 Z4 M. The BMW M56 SULEV engine (sold in several states of the United States) is based on the M54.


title: BMW M54

text: The M54 was phased out following the introduction of the BMW N52 engine in 2004. From 2001 to 2003, the M54 was included on the Ward's 10 Best Engines list.


title: BMW M54

text: Compared with the final versions of its M52 predecessor (called the 'M52TU'), the M54 has a non-return fuel system, a fully electronic throttle (without mechanical backup), Siemens MS 43 engine management, a revised intake manifold. The displacement of the largest variant increased from 2.8 L to , due to an increase in stroke to .


title: BMW M54

text: As per the M52TU, the M54 uses an aluminium block and aluminium cylinder head with cast iron cylinder liners. Variable valve timing is fitted to both camshafts (called "double-VANOS"), a dual length intake manifold (called "DISA") is used and the thermostat is electronically controlled. The redline remains at 6,500 rpm.


title: BMW M54

text: There was no "technical update" (TU) version of the M54 produced, therefore the engine specifications remained the same throughout its seven-year production run.


title: BMW M54

text: The M54B22 produces at 6,100 rpm and at 3,500 rpm. Bore is , stroke is and the compression ratio is 10.8:1.


title: BMW M54

text: The M54B25 produces at 6,000 rpm and at 3,500 rpm. Bore is , stroke is and the compression ratio is 10.5:1.


title: BMW M54

text: The M54B30 is the largest M54 variant and produces at 5,900 rpm and at 3,500 rpm. Bore is , stroke is and the compression ratio is 10.2:1.


title: BMW M54

text: In the United States and Canada, a "ZHP" version of the M54B30 used different camshafts and reprogrammed engine management to develop at 5,900 rpm and at 3,500 rpm and have a slightly higher redline of 6,800 rpm (although the Canadian cars still show the limiter at 6,500 rpm on the tachometer).


title: BMW M54

text: The S54 was marketed as the high performance equivalent to the M54, however it is actually more an evolution of the BMW S50 and shares few parts with the M54. As per the S50, the engine block is made of cast iron (unlike the aluminium engine block used by the M54). Redline is 8,000 rpm.


title: BMW M54

text: There is no direct successor to the S54, since the following generation of M3 is powered by the BMW S65 V8 engine.


title: BMW M54

text: However, in 2014, the S65 V8 engine was replaced with an inline-6 engine called the BMW S55. This is considered the spiritual successor of the S54, being a 6-cylinder engine. This engine was first used in the newly introduced BMW M3 F80 and BMW M4 F82


title: BMW M54

text: Variations in power and torque outputs are often due to country-specific emissions regulations, or space constraints of a chassis affecting the layout of the intake/exhaust system.


title: BMW M54

text: An upgraded version of the S54 engine was used in the E46 M3 CSL. This engine is designated S54B32HP and the changes include a revised intake made from carbon fiber, revised camshafts, a MAP sensor (instead of the MAF sensor used in the regular S54), a lightweight exhaust manifold with a straighter air path (which later became standard on the regular S54) and a straightened intake manifold.


title: Tirana

text: Tirana ( , ; ) is the capital and largest city of Albania. It is located in the centre of the country, enclosed by mountains and hills with Dajti rising to the east and a slight valley to the northwest overlooking the Adriatic Sea in the distance. Due to its location at the Plain of Tirana and the close proximity to the Mediterranean Sea, the city is particularly influenced by a Mediterranean seasonal climate. It is among the wettest and sunniest cities in Europe, with 2,544 hours of sun per year.


title: Tirana

text: Tirana was founded as a city in 1614 by the Ottoman Albanian general Sylejman Pasha Bargjini and flourished by then around the Old Mosque and the "türbe". The area that today corresponds to the city's territory has been continuously inhabited since the Iron Age. It was inhabited by Illyrians, and was most likely the core of the Illyrian Kingdom of the Taulantii, which in Classical Antiquity was centred in the hinterland of Epidamnus. Following the Illyrian Wars it was annexed by Rome and became an integral part of the Roman Empire. The heritage of that period is still evident and represented by the Mosaics of Tirana. Later, in the 5th and 6th centuries, an Early Christian basilica was built around this site.


title: Tirana

text: After the Roman Empire split into East and West in the 4th century, its successor the Byzantine Empire took control over most of Albania, and built the Petrelë Castle in the reign of Justinian I. The city was fairly unimportant until the 20th century, when the Congress of Lushnjë proclaimed it as Albania's capital, after the Albanian Declaration of Independence in 1912.


title: Tirana

text: Classified as a gamma-world-city, Tirana is the most important economic, financial, political and trade centre in Albania due to its significant location in the centre of the country and its modern air, maritime, rail and road transportation. It is the seat of power of the Government of Albania, with the official residences of the President and Prime Minister of Albania, and the Parliament of Albania. The city was announced as the European Youth Capital for 2022.


title: Tirana

text: The area of Tirana has been inhabited by humans since prehistoric times with the earliest recognised reference found at the Cave of Pëllumbas belonging to the Palaeolithic period. Illyrians were the first population of the area and formed most likely the core of the Illyrian kingdom of the Taulantii, which in classical antiquity was centered in the hinterland of Epidamnus. When the Romans arrived in Illyria after their victory of the Illyrian Wars, they populated and integrated the area into their empire under the political control of the city of Rome. The oldest surviving discovery from this period is a Roman house dating to the 3rd century, which was transformed into an aisleless church with a mosaic floor. A castle, possibly known as "Tirkan", was built by the Byzantine Emperor Justinian I between the 4th and 6th century and later restored by Ahmed Pasha Toptani in the 18th century.


title: Tirana

text: Tirana is mentioned in Venetian documents in 1418, one year after the Ottoman conquest of the area: ""...the resident Pjeter, son of late Domenik from the village of Tirana..."". Records of the first land registrations under the Ottomans in 1431–32 show that Tirana consisted of 60 inhabited areas, with nearly 2,028 houses and 7,300 inhabitants. In 1510, Marin Barleti, an Albanian Catholic priest and scholar, in the biography of the Albanian national hero Skanderbeg, "Historia de vita et gestis Scanderbegi Epirotarum principis" ("The story of life and deeds of Skanderbeg, the prince of Epirotes"), referred to this area as a small village, distinguishing between "Little Tirana" and "Great Tirana". It is later mentioned in 1572 as "Borgo di Tirana".


title: Tirana

text: According to Hahn, the settlement had already started to develop as a bazaar and included several watermills, even before 1614, when Sulejman Bargjini, a local ruler, built the Old Mosque, a small commercial centre, and a hammam (Turkish bath). This is confirmed by oral sources, which state that there were two earlier mosques 300–400 m from the Old Mosque, towards today's Ali Demi Street. The Mosque of Reç and the Mosque of Mujo were positioned on the left side of the Lana river and were older than the Old Mosque. Later, the Et'hem Bey Mosque, built by Molla Bey of Petrela, was constructed. It employed the best artisans in the country and was completed in 1821 by Molla's son Etëhem, who was also Sulejman Bargjini's great-nephew.


title: Tirana

text: In 1800, the first newcomers arrived in the settlement, the so-called "ortodoksit". They were Aromanians from villages near Korçë and Pogradec, who settled around modern day Tirana Park on the Artificial Lake. They started to be known as the "llacifac" and were the first Christians to arrive after the creation of the town. In 1807, Tirana became the centre of the Subprefecture of Krujë-Tirana. After 1816, Tirana languished under the control of the "Toptani" family of Krujë. Later, Tirana became a sub-prefecture of the newly created Vilayet of Shkodër and the Sanjak of Durrës. In 1889, the Albanian language started to be taught in Tirana's schools, and the patriotic club Bashkimi was founded in 1908.


title: Tirana

text: On 28 November 1912, the national flag was raised in Vlorë by President Ismail Qemali, marking the symbolic birth of Albania as a sovereign country. The next years, however, were marked by turmoil. During the Balkan Wars, Tirana was temporarily occupied by the Serbian army and it took part in uprising of the villages led by Haxhi Qamili. In August 1916, the first city map was compiled by the specialists of the Austro-Hungarian army. Following the capture of the town of Debar by Serbia, many of its Albanian inhabitants fled to Turkey, the rest went to Tirana. Of those that ended up in Istanbul, some of their number migrated to Albania, mainly to Tirana where the Dibran community formed an important segment of the city's population from 1920 onward and for some years thereafter. On 8 February 1920, the Congress of Lushnjë proclaimed Tirana as the temporary capital of Albania, which had gained independence in 1912. The city acquired that status permanently on 31 December 1925. In 1923, the first regulatory city plan was compiled by Austrian architects. The centre of Tirana was the project of Florestano Di Fausto and Armando Brasini, well-known architects of the Mussolini period in Italy.


title: Tirana

text: Brasini laid the basis for the modern-day arrangement of the ministerial buildings in the city centre.


title: Tirana

text: The plan underwent revisions by Albanian architect Eshref Frashëri, Italian architect Castellani and Austrian architects Weiss and Kohler.


title: Tirana

text: The modern Albanian parliament building served as an officers' club. It was there that, in September 1928, Zog of Albania was crowned King Zog I, King of the Albanians.


title: Tirana

text: During the rule of King Zog a lot of Muhaxhirs emigrated towards Tirana, which lead to a growing population in the capital city in the early 20th century.


title: Tirana

text: In 1939, Tirana was captured by Fascist forces, who appointed a puppet government. In the meantime, Italian architect Gherardo Bosio was asked to elaborate on previous plans and introduce a new project in the area of present-day Mother Teresa Square. A failed assassination attempt was made on Victor Emmanuel III of Italy by a local resistance activist during a visit to Tirana. In November 1941, two emissaries of the Communist Party of Yugoslavia (KPJ), Miladin Popović and Dušan Mugoša, called a meeting of three Albanian communist groups and founded the Communist Party of Albania, and Enver Hoxha soon emerged as its leader.


title: Tirana

text: The town soon became the centre of the Albanian communists, who mobilised locals against Italian fascists and later Nazi Germans, while spreading ideological propaganda. On 4 February 1944, the Gestapo, supported by the forces of Xhafer Deva, executed 86 anti-fascists in Tirana. On 17 November 1944, the town was liberated after a fierce battle between the Communists and German forces. The Nazis eventually withdrew and the communists seized power.


title: Tirana

text: From 1944 to 1991, massive socialist-style apartment complexes and factories were built, while Skanderbeg Square was redesigned, with a number of buildings demolished. For instance, Tirana's former Old Bazaar and the Orthodox Cathedral were razed to the ground in order to build the Soviet-styled Palace of Culture. The northern portion of the main boulevard was renamed Stalin Boulevard and his statue was erected in the city square. Because private car ownership was banned, mass transportation consisted mainly of bicycles, trucks and buses. After Hoxha's death, a pyramidal museum was constructed in his memory by the government.


title: Tirana

text: Before and after the proclamation of Albania's policy of self-imposed isolationism, a number of high-profile figures paid visits to the city, such as Soviet leader Nikita Khrushchev, Chinese Premier Zhou Enlai and East German Foreign Minister Oskar Fischer. In 1985, Enver Hoxha's funeral was held in Tirana. A few years later, Mother Teresa became the first religious figure to visit the country after the end of Albania's long anti-religious atheist stance. She paid respects to her mother and sister resting at a local cemetery.


title: Tirana

text: Starting at the campus and ending at Skanderbeg Square with the toppling of Enver Hoxha's statue, the city saw significant demonstrations by University of Tirana students demanding political freedoms in the early 1990s. On the political aspect, the city witnessed a number of events. Personalities visited the capital, such as former U.S. Secretary of State James Baker and Pope John Paul II.


title: Tirana

text: The former visit came amidst the historical setting after the fall of communism, as hundreds of thousands were chanting in Skanderbeg Square Baker's famous saying of "Freedom works!".


title: Tirana

text: Pope John Paul II became the first major religious leader to visit Tirana, though Mother Teresa had visited few years prior.


title: Tirana

text: During the Balkans turmoil in the mid-1990s, the city experienced dramatic events such as the unfolding of the 1997 unrest in Albania and a failed coup d'état on 14 September 1998.


title: Tirana

text: In 1999, following the Kosovo War, Tirana Airport became a NATO airbase, serving its mission in the former Yugoslavia.


title: Tirana

text: During his term from 2000 to 2011, the former mayor of Tirana, Edi Rama, undertook a campaign to demolish illegal constructed buildings across Tirana as well as along the river banks of Lanë to bring the area to its pre-1990 state. In an attempt to widen roads, Rama authorized the bulldozing of private properties so that they could be paved over, thus widening streets. Most main roads underwent reconstruction, including the Unaza, Rruga e Kavajës and the main boulevard. Rama also led the initiative to paint the façades of Tirana's buildings in bright colours, although much of their interiors continued to degrade. Rama's critics claimed that he focused too much attention on cosmetic changes without fixing any of the major problems such as shortages of drinking water and electricity.


title: Tirana

text: In June 2007, George W. Bush traveled to Tirana on an official state visit becoming the first U.S. President to visit the former communist country. In 2008, the Gërdec explosions were felt in the capital as windows were shattered and citizens shaken. In January 2011, the Albanian opposition demonstrations were triggered in front of the governmental buildings in Tirana protesting against political corruption and state capture, particularly associated with the former prime minister Sali Berisha's government. In September 2014, Pope Francis made an official state visit to Tirana simultaneously becoming the second pontiff to visit Albania, after Pope John Paul II in 1992.


title: Tirana

text: Following the municipal elections of 2015, power was transferred from the Democratic Party representative Lulzim Basha to the Socialist Party candidate Erion Veliaj. Albania then underwent a territorial reform, in which defunct communes were merged with municipalities. Thirteen of Tirana's former communes were integrated as administrative units joining the existing eleven.


title: Tirana

text: Since then, Tirana is undergoing significant changes in infrastructure, law enforcement and new projects, as well as continuing the ones started by Veliaj's predecessor. In their first few council meetings, 242 social houses got allocated to families in need. Construction permits were suspended until the capital's development plan is revised and synthesized.


title: Tirana

text: Between December 2018 and February 2019, a series of demonstrations erupted in the central areas of Tirana and other cities of the country in response to a controversial law on higher education, poor quality of teaching, high tuition rates and corruption. In September 2019, Tirana was ravaged by a 5.6 magnitude earthquake with an epicenter located near Durrës. Two months after, in November 2019, another strong earthquake with the magnitude of 6.4 hit the region again resulting comparatively few damages in Tirana. The same month, Tirana was announced as the European Youth Capital for 2022 with a planned program including events of cultural and social importance.


title: Tirana

text: Tirana extends at the Plain of Tirana in the centre of Albania between the mount of Dajti in the east, the hills of Kërrabe, Sauk and Vaqarr in the south, and a valley to the north overlooking the Adriatic Sea. The average altitude is about above sea level, with a maximum of at Maja Mincekut of Mali me Gropa in Shenmeri.


title: Tirana

text: The city is surrounded by two important protected areas: the Dajti National Park and Mali me Gropa-Bizë-Martanesh Protected Landscape. In winter, the mountains are often covered with snow and are a popular retreat for the population of Tirana, which rarely receives snowfalls. In terms of biodiversity, the forests are mainly composed of pine, oak and beech, while its interior relief is dotted with canyons, waterfalls, caves, lakes and other landforms. Thanks to its natural heritage, it is considered the "Natural Balcony of Tirana". The mountain can be reached by a narrow asphalt mountain road onto an area known as Fusha e Dajtit. From this small area there is an excellent view of Tirana and its plain.


title: Tirana

text: Tiranë river flows through the city, as does the Lanë river. Tirana is home to several artificial lakes, including Tirana, Farka, Tufina, and Kashar. The present municipality was formed in the 2015 local government reform by the merger of the former municipalities of Baldushk, Bërzhitë, Dajt, Farkë, Kashar, Krrabë, Ndroq, Petrelë, Pezë, Shëngjergj, Tirana, Vaqarr, Zall-Bastar and Zall-Herr, which became municipal units. The seat of the municipality is the city of Tirana.


title: Tirana

text: Tirana has a humid subtropical climate ("Cfa") according to the Köppen climate classification and receives enough precipitation during summer to avoid the Mediterranean climate ("Csa") classification.


title: Tirana

text: The average precipitation in Tirana is about per year. The city receives the majority of precipitation in winter months, which occurs from November to March, and less in summer months, from June to September. In terms of precipitation, both rain and snow, the city is ranked among the wettest cities in the European Continent.


title: Tirana

text: Temperatures vary throughout the year from an average of in January to in July. Springs and summers are very warm to hot often reaching over from May to September. During autumn and winter, from November to March, the average temperature drops and is not lower than . The city receives approximately 2500 hours of sun.


title: Tirana

text: In September 2015, Tirana organized its first vehicle-free day, joining forces with numerous cities across the globe to fight against the existing problem of urban air pollution. This initiative resulted in a considerable drop in both air and noise pollution, encouraging the Municipality to organise a vehicle-free day every month.


title: Tirana

text: The city suffers from problems related to overpopulation, such as waste management, high levels of air pollution and significant noise pollution.


title: Tirana

text: Over the last decades, air pollution has become a pressing concern as the number of cars has increased. These are mostly 1990s and early 2000s diesel cars, while it is widely believed that the fuel used in Albania contains larger amounts of sulfur and lead than in the European Union. Effective 1 January 2019, the government has imposed an import ban of used vehicles made prior to 2005 in an effort to curb pollution, encourage the buying of new cars from certified domestic dealerships, and to improve overall road safety. Another source of pollution are PM10 and PM2.5 inhaled particulate matter and NO gases resulting from rapid growth in the construction of new buildings and expanding road infrastructure.


title: Tirana

text: Untreated solid waste is present in the city and outskirts. Additionally, there have been complaints of excessive noise pollution. Despite the problems, the Grand Park at the Artificial Lake has some effect on absorbing CO emissions, while over 2.000 trees have been planted around sidewalks.


title: Tirana

text: Works for four new large parks have started in the summer of 2015 located in Kashar, Farkë, Vaqarr, and Dajt. These parks are part of the new urban plan striving to increase the concentration of green spaces in the capital. The government has included designated green areas around Tirana as part of the Tirana Greenbelt where construction is not permitted or limited.


title: Tirana

text: The municipality of Tirana is encompassed in the County of Tirana within the Central Region of Albania and consists of the rural administrative units of Baldushk, Bërzhitë, Dajt, Farkë, Kashar, Krrabë, Ndroq, Petrelë, Pezë, Shëngjergj, Vaqarr, Zall-Bastar, Zall-Herr and Tirana. The administrative unit of Tirana is further partitioned into eleven urban administrative units, namely Tirana 1, Tirana 2, Tirana 3, Tirana 4, Tirana 5, Tirana 6, Tirana 7, Tirana 8, Tirana 9, Tirana 10 and Tirana 11.


title: Tirana

text: The Mayor of Tirana along with the Cabinet of Tirana exercises executive power. The Assembly of Tirana functions as the city parliament and consists of 55 members, serving four-year terms. It primarily deals with budget, global orientations and relations between the city and the Government of Albania. It has 14 committees and its chairman is Aldrin Dalipi from the Socialist Party. Each of the members have a specific portfolio such as economy, finance, juridical, education, health care, and several professional services, agencies and institutes.


title: Tirana

text: In 2000, the centre of Tirana from the central campus of University of Tirana in the Mother Teresa Square up to the Skanderbeg Square, was declared the place of Cultural Assembly, and given state protection. The historical core of the capital lies around pedestrian only Murat Toptani Street, while the most prominent city district is Blloku. In 2010, the municipality undertook the installing of street name signs and entrance numbers while every apartment entrance was physically stamped.


title: Tirana

text: Tirana is the capital city of the Republic of Albania thus playing an essential role in shaping the political and economic life of the country. It is the home to government functions and institutions for which the government of Albania is responsible, as for instance the executive, juridical and legislative branches of Albania.


title: Tirana

text: The President and Prime Minister of Albania officially reside and work in Tirana specifically at the Presidenca and Kryeministria, respectively, nevertheless the Parliament of Albania is headquartered at the Dëshmorët e Kombit Boulevard. Tirana is also the home to the national Constitutional Court and Supreme Court. Important national institutions housed in Tirana include the Appeal Court and Administrative Court.


title: Tirana

text: The Bank of Albania is located at the Skanderbeg Square while other institutions such as the ministries of Culture, Defence, Education, Finance, Foreign Affairs, Health, Infrastructure, Internal Affairs, Justice and Tourism are spread over Tirana. The city is also the home to all the consulates and embassies in Albania, thereby making it an important centre for international diplomacy in the country.


title: Tirana

text: Tirana is a founding member of the Union of Albanian Municipalities in the Region. Tirana is twinned with Ankara, Beijing, Bursa, Doha, Florence, Kharkiv, Sarajevo and has signed partnership agreements with Verona and Zagreb. It has also signed special bilateral agreements with Zaragoza.


title: Tirana

text: Tirana is the heart of the economy of Albania and the most industrialised and economically fastest growing region in Albania. Of the main sectors, the tertiary sector is the most important for the economy of Tirana and employs more than 68% of work force of Tirana. 26% of the working population makes up the secondary sector followed by the primary sector with only 5%.


title: Tirana

text: The city began to develop at the beginning of the 16th century as it was part of the Ottoman Empire, when a bazaar was established, and its craftsmen manufactured silk and cotton fabrics, leather, ceramics and iron, silver and gold artefacts. In the 20th century, the city and its surrounding areas expanded rapidly and became the most heavily industrialised region of the country.


title: Tirana

text: The most significant contribution is made by the tertiary sector which has developed considerably since the fall of communism in Albania. Forming the financial centre of the country, the financial industry is a major component of the city's tertiary sector and remains in good conditions overall due to privatization and the commendable monetary policy. All of the most important financial institutions, such as the Bank of Albania and the Albanian Stock Exchange are centred in Tirana as well as most of the banking companies such as the Banka Kombëtare Tregtare, Raiffeisen Bank, Credins Bank, Intesa Sanpaolo Bank and Tirana Bank.


title: Tirana

text: The telecommunication industry represents another major and growing contributor to the sector. A rapid development occurred as well as after the end of communism and decades of isolationism mainly due to the new national policy of reform and opening up sped up the industry's development. Vodafone, Telekom Albania and Eagle are the leading telecommunication providers in Tirana, as in all the country.


title: Tirana

text: The tourism industry of the city has expanded in recent years to become a vital component of the economy. Tirana has been officially dubbed as 'The Place Beyond Belief' by local authorities. The increasing number of international arrivals at the Tirana International Airport and Port of Durrës from across Europe, Australia and Asia has rapidly grown the number of foreign visitors in the city.


title: Tirana

text: The largest hotels of the city are the Tirana International Hotel, Maritim Plaza Tirana both situated in the heart of the city near Scanderbeg Square, and the Hyatt-owned luxury Mak Hotel Tirana located next to the Air Albania Stadium, where Mariott Tirana Hotel is also planned to open. Other major hotels present in central Tirana include the Rogner Hotel, Hilton Garden Inn Tirana, Xheko Imperial Hotel, Best Western Premier Ark Hotel, and Mondial Hotel.


title: Tirana

text: Tirana is served by Nënë Tereza International Airport, which is simultaneously the premier air gateway to the country. The airport was officially named in honour of the Albanian Roman Catholic nun and missionary, Mother Teresa. It connects Tirana with many destinations in different countries across Europe, Africa and Asia. The airport carried more than 3.3 million passengers in 2019 and is also the principal hub for the country's flag carrier, Air Albania.


title: Tirana

text: The city's geographical location in the centre of Albania has long established the city as an integral terminus for the national road transportation, thus connecting the city to all parts of Albania and the neighbouring countries. The Rruga Shtetërore 1 (SH1) connects Tirana with Shkodër and Montenegro in the north, and constitutes an essential section of the proposed Adriatic–Ionian motorway.


title: Tirana

text: The Rruga Shtetërore 2 (SH2) continues in the west and provides direct connection to Durrës on the Adriatic Sea. The Rruga Shtetërore 3 (SH3) is being transformed to the Autostrada 3 (A3) and follows the ancient Via Egnatia. It significantly constitutes a major section of the Pan-European Corridor VIII and links the city with Elbasan, Korçë and Greece in the south. Tirana is further connected, through the Milot interchange in the northwest, with Kosovo following as part of the Autostrada 1 (A1).


title: Tirana

text: During the communist regime in Albania, a plan for the construction of a ring road around Tirana arose in 1989s with no implementation until the 2010s. It is of major importance, especially concerning the demographic growth of the metropolitan region of Tirana as well as the importance of the economy. Although, constructions for the nowadays completed southern section of the ring road started in 2011, however, the northern and eastern sections are still in the planning process.


title: Tirana

text: Rail lines of Hekurudha Shqiptare (HSH) connected Tirana with all of the major cities of Albania, including Durrës, Shkodër and Vlorë. In 2013, the Tirana Railway Station was closed and moved to Kashar by the government of Tirana in order to create space for the Bulevardi i Ri project. The new Tirana Station will be constructed in Laprakë, which is projected to be a multifunctional terminal for rail, tram and bus transportation. Furthermore, a new rail line from Tirana through Nënë Tereza International Airport to Durrës is planned to be constructed.


title: Tirana

text: In 2012, Tirana municipality published a report according to which a project on the construction of two tram lines was under evaluation. The tram lines would have a total length of . The public transport in Tirana is, for now, focused only in the city centre, so that the people living in the suburbs have fewer or no public transport connections.


title: Tirana

text: Under the plan, the two tram lines will intersect in the Skanderbeg Square. The public transport system in Tirana is ten bus lines served by 250 to 260 buses every day.


title: Tirana

text: During the administration of mayor Erion Veliaj, the government of Tirana has significantly increased the creation and expansion of a cycling infrastructure in the city in order to reduce traffic congestion as well as to improve the sustainable transportation. Ecovolis was launched in 2011 offering rental services for bicycles at different centrally located stations for a small fee. The international bicycle sharing system, Mobike, launched its operations on 8 June 2018 by deploying 4000 bicycles in the city.


title: Tirana

text: Tirana has the highest concentration of institutions of tertiary education in Albania, consisting of numerous academies, colleges and universities. Most prominent among these is the University of Tirana with campuses around the city and more than 28,000 students from all backgrounds. The Polytechnic University of Tirana is another distinguished institution and also the most renowned engineering and technical university in the country. The four other public institutions in Tirana are the University of Arts, University of Agriculture, University of Medicine and University of Sports.


title: Tirana

text: The educational system of Tirana has expanded substantially over the past years with the renovations of existing school facilities and the construction of new schools. For primary and secondary education, a variety of schools are available, tagged with the public, private and international labels. Few of the major international schools are the Tirana International School, Albanian International School, British School, Montessori School, Memorial Schooland and World Academy. Also of noteworthy mention is the public primary and secondary Servete Maçi School, which received international recognition as it won an award at the 2020 International Architecture Awards.


title: Tirana

text: There are numerous public and private hospitals as well as smaller public and private health care facilities in the territory of Tirana. The Mother Teresa University Hospital is one of the largest medical tertiary institutions of the country. Other medical institutions include the Shefqet Ndroqi University Hospital, Koço Gliozheni Hospital, Mbretëresha Gjeraldinë Hospital and the Military Hospital.


title: Tirana

text: The Institute of Statistics (INSTAT) estimated the population of the municipality of Tirana at 418,495 in 2011. With a population density of 502 people per square kilometre, Tirana is the most densely populated municipality in the country. The encompassing metropolitan area, consisting of the regions of Durrës and Tirana, has a combined population of approximately 1 million amounting to nearly one third of the country's total population.


title: Tirana

text: Historically, Tirana has experienced a steady population increase in the past years, especially after the fall of communism in the late twentieth century as well as the beginnings of the twenty-first century. The remarkable growth was, and still is, largely fueled by migrants from all over the country often in search of employment and improved living conditions. Between 1820 and 1955, the population of Tirana tenfolded while during the period from 1989 to 2011, the city's population grew annually by approximately 2.7%. In the 19th and 20th centuries, the city had a rate of growth less than 1% annually until the 1970s, then down to less than 8% per year until the middle 20th century figures.


title: Tirana

text: Tirana's population is composed by a mixture of different cultural and ethnic groups from Southern Europe. The most represented ethnicities are Albanians (84.10%), Greeks (0.35%), Aromanians (0.11%), Macedonians (0.07%) and Italians (0.03%).


title: Tirana

text: In Albania, a secular state with no state religion, the freedom of belief, conscience and religion is explicitly guaranteed in the constitution of Albania. Tirana is religiously diverse and has many places of worship catering to its religious population whom are adherents of Islam, Christianity and Judaism but also of Atheism and Agnosticism. They all maintain their Albanian headquarters spread across the territory of Tirana. Nevertheless, the Bektashi Order leadership established their world centre also in the city.


title: Tirana

text: In the 2011 census, 55.7% of the population of the municipality of Tirana was counted as Muslim, 3.4% as Bektashis and 11.8% as Christian including 5.4% as Roman Catholic and 6.4% as Eastern Orthodox. The remaining 29.1% of the population reported having no religion or did not provide an adequate answer. The census of 2011 did not included specific municipality level data for other religious groups. The Roman Catholic Church is represented in Tirana by the Archdiocese of Tiranë and Durrës, with the St Paul's Cathedral as the seat of the prelacy. The Albanian Orthodox community is served by the Archbishop of Tirana in the Resurrection Cathedral.


title: Tirana

text: Tirana offers a blend of traditional and modern lifestyle with a variety of arts, food, entertainment, music and night life. Its population celebrates a wide range of religious and other festivals including Christmas, Eid, Hanukkah and Nowruz. Another festival is Dita e Verës taking place every year on 14 March, during which the Albanians celebrate the end of winter and the arrival of spring.


title: Tirana

text: Among the local institutions are the National Library, that keeps more than a million books, periodicals, maps, atlases, microfilms and other library materials. The city has five well-preserved traditional houses (museum-houses), 56 cultural monuments, eight public libraries.


title: Tirana

text: There are many domestic and foreign cultural institutions in Tirana, amongst them the British Council, Canadian Institute of Technology as well as the German Goethe-Institut and Friedrich Ebert Foundation. Other cultural institutions include the Chinese Confucius Institute, Greek Hellenic Foundation for Culture, Italian Istituto Italiano di Cultura and the French Alliance Française.


title: Tirana

text: Tirana is home to a mixture of architectural styles reflecting the influential periods in its history. Its current appearance was considerably shaped by two totalitarian regimes, once by the fascist regime of Benito Mussolini during the Second World War and the regime of Enver Hoxha in the aftermath. The Palace of Brigades, the ministries buildings, the government building and the municipality hall are designed by Florestano Di Fausto and Armando Brasini, both well-known architects of the Mussolini period in Italy. The Dëshmorët e Kombit Boulevard was built in 1930 and given the name King Zog I Boulevard.


title: Tirana

text: In the 20th century, the part from Skanderbeg Square up to the train station was named Stalin Boulevard. The Royal Palace or Palace of Brigades previously served as the official residence of King Zog I. It has been used by different Albanian governments for various purposes. Because of the outbreak of World War II, and the 1939 Italian invasion of Albania, King Zog I fled Albania and never had a chance to see the Palace fully constructed. The Italians finished it and used it as the Army Headquarters. The Palace took its nickname Palace of Brigades because it was taken from the Italians by a people's army brigade.


title: Tirana

text: In the 21st century, Tirana turned into a proper modernist city, with large blocks of flats, modern new buildings, new shopping centres and many green spaces. In June 2016, the Mayor of Tirana Erion Veliaj and the Italian architect Stefano Boeri announced the start of the works for the redaction of the Master Plan "Tirana 2030".


title: Tirana

text: Tirana is a densely-built area and still offers several public parks throughout its districts, graced with green gardens. The Grand Park is the most important green space in Tirana. It is one of most visited areas by local citizens. The park includes many children's playgrounds, sport facilities and landmarks such as the Saint Procopius Church, the Presidential Palace, the Botanical Gardens, the Tirana Zoo, the Amphitheatre, the Monument of the Frashëri Brothers and many others.


title: Tirana

text: The Rinia Park was built during the Communist regime in Albania. It bordered by Dëshmorët e Kombit Boulevard to the east, Gjergi Fishta Boulevard and Bajram Curri Boulevard to the south, Rruga Ibrahim Rugova to the west and Rruga Myslym Shyri to the north. The Taivani Centre is the main landmark in the park and houses cafés, restaurants, fountains, and a bowling lane in the basement. The Summer Festival takes place every year in the park, to celebrate the end of winter and the rebirth of nature and a rejuvenation of spirit amongst the Albanians.


title: Tirana

text: As of the Mayor of Tirana Erion Veliaj, the Municipality of Tirana will build more green spaces and will plant more trees.


title: Tirana

text: As one of the cultural centres of the country, Tirana is the home to a number of museums dedicated to a wide array of arts. The National Museum of History is located at the Skanderbeg Square and the most representative museum of Tirana. The mosaic above the entrance is the most dominant feature of the museum displaying the story of how the Albanian people have fought against invasion and occupation throughout history.


title: Tirana

text: Founded in 1948, the National Museum of Archaeology at the Mother Teresa Square displays a wide collection of research and discoveries belonging to the archaeological locations around Albania. It exhibits span from prehistory through antiquity and the Middle Ages to the twentieth century, offering an overview of the country's historical diversity.


title: Tirana

text: The National Art Gallery is considered the most important gallery in Albania housing one of the greatest collections of paintings in the region. Located at the Dëshmorët e Kombit Boulevard, it holds approximately 4.500 works of art including the most important collection of Albanian art of the nineteenth and twentieth centuries.


title: Tirana

text: The Bunk'art Museum consists of two underground bunkers in Tirana built under the orders and direction of Enver Hoxha during the communist regime in the country. Located at the Fadil Deliu Street and Abdi Toptani Street respectively, the bunkers have been transformed into a history museum and contemporary art gallery with exhibits from the Second World War and Cold War.


title: Tirana

text: The Museum of Secret Surveillance was founded in 2017 and is housed within a twentieth century mansion, the building known as the "House of Leaves", near the Dëshmorët e Kombit Boulevard. It commemorates and honours the victims who fell to the communist terrorism and violence during the communist period in Albania. Other museums include the Natural Sciences Museum, which has branches in zoology, botany and geology, the former Enver Hoxha Museum and the Bunk'art Museum.


title: Tirana

text: The Bektashi Museum was opened at the World Headquarters of the Bektashi on 7 September 2015. The museum contains exhibits relating to Bektashi history and leadership.


title: Tirana

text: As in other parts of Albania, agricultural traditions are of great significance to the Albanians in Tirana, substantially appreciated for the production of food such as cheese, olives and wine. In 2016, Albania surpassed Spain by becoming the country with the most coffee houses per capita in the world with 654 coffee houses per 100,000 inhabitants. This is due to coffee houses closing down in Spain due to the economic crisis, and the fact that as many cafes open as they close in Albania. In addition, the fact that it was one of the easiest ways to make a living after the fall of communism in Albania, together with the country's Ottoman legacy further reinforce its strong dominance in Albania.


title: Tirana

text: Tirana's restaurant scene has evolved recently characterised by stylish interiors and delicious food grown locally. The Tirana region is known for the Fergesa traditional dish made with either peppers or liver, and is found at a number of traditional restaurants in the city and agri-tourism sites on the outskirts of Tirana.


title: Tirana

text: Being the capital, Tirana is the centre of sport in Albania, where activity is organised across amateur and professional levels. It is home to many major sporting facilities. Starting from 2007, the Tirana Municipality has built up to 80 sport gardens in most of Tirana's neighborhoods. One of the latest projects is the reconstruction of the existing Olympic Park, that will provide infrastructure for most intramural sports.


title: Tirana

text: Tirana hosted in the past three major events, the FIBA EuroBasket 2006, 2011 World Mountain Running Championships and the 2013 European Weightlifting Championships.


title: Tirana

text: There are two major stadiums, the former Qemal Stafa Stadium and the Selman Stërmasi stadium. The former was demolished in 2016 to make way for the new national stadium. The new stadium called the "Air Albania Stadium" was constructed on the same site of the former Qemal Stafa Stadium and it is planned to open in late 2019. It will have an underground parking, Marriott Tirana Hotel, shops and bars and will be used for entertainment events. Tirana's sports infrastructure is developing fast because of the investments from the municipality and the government.


title: Tirana

text: Football is the most widely followed sport in Tirana as well as in the country, having numerous club teams including the KF Tirana, Partizani Tirana, and Dinamo Tirana. It is popular at every level of society, from children to wealthy professionals. In football, as of April 2012, the Tirana-based teams have won a combined 57 championships out of 72 championships organised by the FSHF, i.e. 79% of them. Another popular sport in Albania is basketball, represented in particular by the teams KB Tirana, BC Partizani, BC Dinamo, Ardhmëria and also the women's PBC Tirana.


title: Tirana

text: Recently two rugby teams were created: Tirana Rugby Club, founded in 2013 and Ilirët Rugby Club founded in 2016.


title: Tirana

text: As the capital, Tirana is the most significant location for the Albanian media industry whose content is distributed throughout Albania, Kosovo and other Albanian-speaking territories. Tirana is the home to most of the national and international television stations, including the national broadcaster, Radio Televizioni Shqiptar (RTSH), along with all its television and radio networks. The three largest Albanian commercial broadcasters, such as Televizioni Klan, Top Channel and Vizion Plus, also maintains their headquarters in the city. The European broadcaster, Euronews, operates a franchise in the city as well as the American broadcaster CNN.


title: Tirana

text: Tirana is also a principal location for the largest Albanian newspapers, magazines and publications. The newspapers with the largest circulations in Albania are published in Tirana, including Gazeta Shqip, Gazeta Tema, Koha Jonë and Panorama. Gazeta Shqiptare, one of the oldest Albanian-language newspapers in Albania, operates and has its headquarters in the city. Tirana also has a well-established English-language newspaper, notably the daily of Tirana Times.


title: Tirana

text: The "Key of Tirana" () is a symbolic recognition given by the Mayor of Tirana to an esteemed personality. It was given to:


title: Hydrocephalus

text: Hydrocephalus is a condition in which an accumulation of cerebrospinal fluid (CSF) occurs within the brain. This typically causes increased pressure inside the skull. Older people may have headaches, double vision, poor balance, urinary incontinence, personality changes, or mental impairment. In babies, it may be seen as a rapid increase in head size. Other symptoms may include vomiting, sleepiness, seizures, and downward pointing of the eyes.


title: Hydrocephalus

text: Hydrocephalus can occur due to birth defects or be acquired later in life. Associated birth defects include neural tube defects and those that result in aqueductal stenosis. Other causes include meningitis, brain tumors, traumatic brain injury, intraventricular hemorrhage, and subarachnoid hemorrhage. The four types of hydrocephalus are communicating, noncommunicating, "ex vacuo", and normal pressure. Diagnosis is typically made by physical examination and medical imaging.


title: Hydrocephalus

text: Hydrocephalus is typically treated by the surgical placement of a shunt system. A procedure called a third ventriculostomy is an option in some people. Complications from shunts may include overdrainage, underdrainage, mechanical failure, infection, or obstruction. This may require replacement. Outcomes are variable, but many people with shunts live normal lives. Without treatment, death or permanent disability may occur.


title: Hydrocephalus

text: About one to two per 1,000 newborns have hydrocephalus. Rates in the developing world may be higher. Normal pressure hydrocephalus is estimated to affect about 5 per 100,000 people, with rates increasing with age. Description of hydrocephalus by Hippocrates dates back more than 2,000 years. The word "hydrocephalus" is from the Greek , meaning 'water' and , meaning 'head'.


title: Hydrocephalus

text: The clinical presentation of hydrocephalus varies with chronicity. Acute dilatation of the ventricular system is more likely to manifest with the nonspecific signs and symptoms of increased intracranial pressure (ICP). By contrast, chronic dilatation (especially in the elderly population) may have a more insidious onset presenting, for instance, with Hakim's triad (Adams' triad).


title: Hydrocephalus

text: Symptoms of increased ICP may include headaches, vomiting, nausea, papilledema, sleepiness, or coma. With increased levels of CSF, there have been cases of hearing loss due to CSF creating pressure on the auditory pathways or disrupting the communication of inner ear fluid. Elevated ICP of different etiologies have been linked to sensorineural hearing loss (SNHL). Transient SNHL has been reported after the loss of CSF with shunt surgeries. Hearing loss is a rare but well-known sequela of procedures resulting in CSF loss. Elevated ICP may result in uncal or tonsillar herniation, with resulting life-threatening brain stem compression.


title: Hydrocephalus

text: Hakim's triad of gait instability, urinary incontinence, and dementia is a relatively typical manifestation of the distinct entity normal-pressure hydrocephalus. Focal neurological deficits may also occur, such as abducens nerve palsy and vertical gaze palsy (Parinaud syndrome due to compression of the quadrigeminal plate, where the neural centers coordinating the conjugated vertical eye movement are located). The symptoms depend on the cause of the blockage, the person's age, and how much brain tissue has been damaged by the swelling.


title: Hydrocephalus

text: In infants with hydrocephalus, CSF builds up in the central nervous system (CNS), causing the fontanelle (soft spot) to bulge and the head to be larger than expected. Early symptoms may also include:


title: Hydrocephalus

text: Because hydrocephalus can injure the brain, thought and behavior may be adversely affected. Learning disabilities, including short-term memory loss, are common among those with hydrocephalus, who tend to score better on verbal IQ than on performance IQ, which is thought to reflect the distribution of nerve damage to the brain. Hydrocephalus that is present from birth can cause long-term complications with speech and language. Children can have issues such as nonverbal learning disorder, difficulty understanding complex and abstract concepts, difficulty retrieving stored information, and spatial/perceptual disorders. Children with hydrocephalus are often known in having the difficulty in understanding the concepts within conversation and tend to use words they know or have heard. However, the severity of hydrocephalus can differ considerably between individuals, and some are of average or above-average intelligence. Someone with hydrocephalus may have coordination and visual problems, or clumsiness. They may reach puberty earlier than the average child (this is called precocious puberty). About one in four develops epilepsy.


title: Hydrocephalus

text: Congenital hydrocephalus is present in the infant prior to birth, meaning the fetus developed hydrocephalus "in utero" during fetal development. The most common cause of congenital hydrocephalus is aqueductal stenosis, which occurs when the narrow passage between the third and fourth ventricles in the brain is blocked or too narrow to allow sufficient cerebral spinal fluid to drain. Fluid accumulates in the upper ventricles, causing hydrocephalus.


title: Hydrocephalus

text: Other causes of congenital hydrocephalus include neural-tube defects, arachnoid cysts, Dandy–Walker syndrome, and Arnold–Chiari malformation.


title: Hydrocephalus

text: The cranial bones fuse by the end of the third year of life. For head enlargement to occur, hydrocephalus must occur before then. The causes are usually genetic, but can also be acquired and usually occur within the first few months of life, which include intraventricular matrix hemorrhages in premature infants, infections, type II Arnold-Chiari malformation, aqueduct atresia and stenosis, and Dandy-Walker malformation. Hydrocephalus has also been seen in cases of congenital syphilis.


title: Hydrocephalus

text: In newborns and toddlers with hydrocephalus, the head circumference is enlarged rapidly and soon surpasses the 97th percentile. Since the skull bones have not yet firmly joined, bulging, firm anterior and posterior fontanelles may be present even when the person is in an upright position.


title: Hydrocephalus

text: The infant exhibits fretfulness, poor feeding, and frequent vomiting. As the hydrocephalus progresses, torpor sets in, and infants show lack of interest in their surroundings. Later on, their upper eyelids become retracted and their eyes are turned downwards ("sunset eyes") (due to hydrocephalic pressure on the mesencephalic tegmentum and paralysis of upward gaze). Movements become weak and the arms may become tremulous. Papilledema is absent, but vision may be reduced. The head becomes so enlarged that they eventually may be bedridden.


title: Hydrocephalus

text: About 80–90% of fetuses or newborn infants with spina bifida—often associated with meningocele or myelomeningocele—develop hydrocephalus.


title: Hydrocephalus

text: This condition is acquired as a consequence of CNS infections, meningitis, brain tumors, head trauma, toxoplasmosis, or intracranial hemorrhage (subarachnoid or intraparenchymal), and is usually painful.


title: Hydrocephalus

text: The cause of hydrocephalus is not known with certainty and is probably multifactorial. It may be caused by impaired CSF flow, reabsorption, or excessive CSF production.


title: Hydrocephalus

text: Hydrocephalus can be classified into communicating and noncommunicating (obstructive). Both forms can be either congenital or acquired.


title: Hydrocephalus

text: Communicating hydrocephalus, also known as nonobstructive hydrocephalus, is caused by impaired CSF reabsorption in the absence of any obstruction of CSF flow between the ventricles and subarachnoid space. This may be due to functional impairment of the arachnoidal granulations (also called arachnoid granulations or Pacchioni's granulations), which are located along the superior sagittal sinus, and is the site of CSF reabsorption back into the venous system. Various neurologic conditions may result in communicating hydrocephalus, including subarachnoid/intraventricular hemorrhage, meningitis, and congenital absence of arachnoid villi. Scarring and fibrosis of the subarachnoid space following infectious, inflammatory, or hemorrhagic events can also prevent reabsorption of CSF, causing diffuse ventricular dilatation.


title: Hydrocephalus

text: Noncommunicating hydrocephalus, or obstructive hydrocephalus, is caused by an obstruction to the flow of CSF.


title: Hydrocephalus

text: Hydrocephalus is usually due to blockage of CSF outflow in the ventricles or in the subarachnoid space over the brain. In a person without hydrocephalus, CSF continuously circulates through the brain, its ventricles and the spinal cord and is continuously drained away into the circulatory system. Alternatively, the condition may result from an overproduction of the CSF, from a congenital malformation blocking normal drainage of the fluid, or from complications of head injuries or infections.


title: Hydrocephalus

text: Compression of the brain by the accumulating fluid eventually may cause neurological symptoms such as convulsions, intellectual disability, and epileptic seizures. These signs occur sooner in adults, whose skulls are no longer able to expand to accommodate the increasing fluid volume within. Fetuses, infants, and young children with hydrocephalus typically have an abnormally large head, excluding the face, because the pressure of the fluid causes the individual skull bones—which have yet to fuse—to bulge outward at their juncture points. Another medical sign, in infants, is a characteristic fixed downward gaze with whites of the eyes showing above the iris, as though the infant were trying to examine its own lower eyelids.


title: Hydrocephalus

text: The elevated ICP may cause compression of the brain, leading to brain damage and other complications. A complication often overlooked is the possibility of hearing loss due to ICP. The mechanism of ICP on hearing loss is presumed that the transmission of CSF pressure to and from the Perilymphatic space through a patent cochlear aqueduct. The cochlear aqueduct connects the Perilymphatic space of the inner ear with the subarachnoid space of the posterior cranial fossa. A loss of CSF pressure can induce Perilymphatic loss or endolymphatic hydrops resembling the clinical presentation of Ménière's disease associated hearing loss in the low frequencies.


title: Hydrocephalus

text: CSF can accumulate within the ventricles, this condition is called internal hydrocephalus and may result in increased CSF pressure. The production of CSF continues, even when the passages that normally allow it to exit the brain are blocked. Consequently, fluid builds inside the brain, causing pressure that dilates the ventricles and compresses the nervous tissue. Compression of the nervous tissue usually results in irreversible brain damage. If the skull bones are not completely ossified when the hydrocephalus occurs, the pressure may also severely enlarge the head. The cerebral aqueduct may be blocked at the time of birth or may become blocked later in life because of a tumor growing in the brainstem.


title: Hydrocephalus

text: Hydrocephalus treatment is surgical, creating a way for the excess fluid to drain away. In the short term, an external ventricular drain (EVD), also known as an extraventricular drain or ventriculostomy, provides relief. In the long term, some people will need any of various types of cerebral shunt. It involves the placement of a ventricular catheter (a tube made of silastic) into the cerebral ventricles to bypass the flow obstruction/malfunctioning arachnoidal granulations and drain the excess fluid into other body cavities, from where it can be resorbed. Most shunts drain the fluid into the peritoneal cavity (ventriculoperitoneal shunt), but alternative sites include the right atrium (ventriculoatrial shunt), pleural cavity (ventriculopleural shunt), and gallbladder. A shunt system can also be placed in the lumbar space of the spine and have the CSF redirected to the peritoneal cavity (lumbar-peritoneal shunt). An alternative treatment for obstructive hydrocephalus in selected people is the endoscopic third ventriculostomy (ETV), whereby a surgically created opening in the floor of the third ventricle allows the CSF to flow directly to the basal cisterns, thereby shortcutting any obstruction, as in aqueductal stenosis. This may or may not be appropriate based on individual anatomy. For infants, ETV is sometimes combined with choroid plexus cauterization, which reduces the amount of cerebrospinal fluid produced by the brain. The technique, known as ETV/CPC, was pioneered in Uganda by neurosurgeon Benjamin Warf and is now in use in several U.S. hospitals. Hydrocephalus can be successfully treated by placing a drainage tube (shunt) between the brain ventricles and abdominal cavity. Some risk exists of infection being introduced into the brain through these shunts, however, and the shunts must be replaced as the person grows.


title: Hydrocephalus

text: External hydrocephalus is a condition generally seen in infants which involves enlarged fluid spaces or subarachnoid spaces around the outside of the brain. This condition is generally benign, and resolves spontaneously by two years of age and therefore usually does not require insertion of a shunt. Imaging studies and a good medical history can help to differentiate external hydrocephalus from subdural hemorrhages or symptomatic chronic extra-axial fluid collections which are accompanied by vomiting, headaches, and seizures.