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Flubromazepam intoxication causing prolonged coma and multifocal cerebral ischaemia.

Lotte Pitlo1, Ynte M Ruigrok1, Fedor E L Migchelsen2

  • 1Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands.

Practical Neurology
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Summary

Novel psychoactive substance flubromazepam intoxication can cause severe neurological issues like decreased consciousness and brain ischemia. Early identification is crucial for managing this dangerous designer benzodiazepine. Keywords: flubromazepam, novel psychoactive substance, benzodiazepine, intoxication, brain ischemia.

Keywords:
CEREBRAL BLOOD FLOWCEREBROVASCULARCEREBROVASCULAR DISEASENEUROTOXICOLOGYTOXICOLOGY

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Area of Science:

  • Neuroscience
  • Toxicology
  • Pharmacology

Background:

  • Novel psychoactive substances (NPS), including designer benzodiazepines like flubromazepam, pose diagnostic challenges.
  • Intoxication with NPS can lead to severe and unexplained neurological symptoms.

Purpose of the Study:

  • To highlight the diagnostic difficulties and clinical presentation of flubromazepam intoxication.
  • To emphasize the importance of considering NPS toxicity in patients with neurological emergencies.

Main Methods:

  • Case report of a patient presenting with decreased consciousness and multifocal intracerebral ischemia.
  • Exclusion of other potential etiologies.
  • Toxicology screening to identify flubromazepam use.

Main Results:

  • Flubromazepam intoxication was identified as the cause of the patient's severe neurological presentation.
  • Flubromazepam has a long elimination half-life (106 hours) and can cause life-threatening side effects like hypotension and sedative-hypnotic toxidrome.
  • The increasing use of flubromazepam correlates with a significant risk of serious toxicity.

Conclusions:

  • Physicians must consider NPS toxicity, particularly flubromazepam, in patients with unexplained neurological symptoms.
  • Early recognition and diagnosis of flubromazepam intoxication are critical for appropriate patient management.
  • Flubromazepam poses a significant public health risk due to its potential for severe toxicity.