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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.
Abstract:
Intoxication with novel psychoactive substances, such as the designer benzodiazepine flubromazepam, can be diagnostically challenging. A man in his late 50s presented with a persistently decreased level of consciousness and extensive multifocal intracerebral ischaemia on an MR brain scan. After excluding multiple causes, a toxicology screen identified flubromazepam use as the likely explanation. This novel psychoactive substance has an elimination half-life of 106 hours and life-threatening side effects, including hypotension and sedative-hypnotic toxidrome. Flubromazepam is increasingly used, with a significant risk of serious toxicity. Physicians should consider novel psychoactive substance toxicity in patients with unexplained neurological presentations, particularly with decreased consciousness and multifocal intracerebral ischaemia.
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