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.
Pitlo et al. (2026) studied this question.