What is “the Horowitz Dodecad,” and what does it indicate?
The Horowitz Dodecad: Dry mouth, Diplopia, Dilated pupils, Droopy eyes (ptosis), Droopy face, Diminished gag reflex, Dysphagia (difficulty swallowing), Dysarthria (difficulty articulating speech), Dysphonia (difficulty phonating/whispered speech), Difficulty lifting head, Descending paralysis, Diaphragmatic paralysis. All are signs of botulism (in order of appearance). The combination of any 3 or 4 of these signs should prompt evaluation and treatment for botulism.
Horowitz BZ. Botulinum toxin. Crit Care Med. 2005;21(4):825–39.
Contributed by: Michael Mullins, MD
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