LORAZEPAM FOR THE MANAGEMENT OF POSTERIOR FOSSA MUTISM: A CASE REPORT Posterior Fossa Syndrome (PFS) is a condition that can develop in children and adults following a cerebellar tumor resection surgery. The syndrome is characterized by multiple symptoms, including mutism, personality changes, and mobility problems. We present a case of a four-year-old boy diagnosed with posterior fossa tumor with secondary hydrocephalus who underwent an uneventful total resection of the tumor and developed posterior fossa syndrome, including mutism, was managed using lorazepam and made a full recovery of almost all of the symptoms he developed. Posterior fossa syndrome has multiple symptoms, most of which are usually transient. The exact pathophysiology and time to recovery are still not fully known. Patients with posterior fossa syndrome are managed with a multidisciplinary approach. Mutism resulting from this syndrome is proven to be successfully managed by lorazepam. ASEAN Journal of Psychiatry, Vol. 25 (5) May, 2024; 1-5.

BACKGROUND:We compare educational environments (i.e. physical, emotional and intel ectual experiences) of emergency medicine (EM) residents training in the United States of America (USA) and Saudi Arabia (SA). METHODS:A cross-sectional survey study was conducted using an adapted version of the validated Postgraduate Hospital Educational Environment Measure (PHEEM) survey instrument from April 2015 through June 2016 to compare educational environments in all emergency medicine residency programs in SA and three selected programs in the USA with a history of training Saudi physicians. Overall scores were compared across programs, and for subscales (autonomy, teaching, and social Support), using chi-squared, t-tests, and analysis of variance. RESULTS:A total of 219 surveys were returned for 260 residents across six programs (3 SA, 3 USA), with a response rate of 84％. Program-specific response rates varied from 79％–100％. All six residencies were qualitatively rated as "more positive than negative but room for improvement". Quantitative PHEEM scores for the USA programs were significantly higher:118.7 compared to 109.9 for SA, P=0.001. In subscales, perceptions of social support were not different between the two countries (P=0.243); however, role autonomy (P<0.001) and teaching (P=0.005) were better in USA programs. There were no significant differences by post-graduate training year. CONCLUSION:EM residents in all three emergency medicine residency programs in SA and the three USA programs studied perceive their training as high quality in general, but with room for improvements. USA residency programs scored higher in overall quality. This was driven by more favorable perceptions of role autonomy and teaching. Understanding how residents perceive their programs may help drive targeted quality improvement efforts.