Some patients will remember having a tick bite or symptoms of primary (stage 1) Lyme disease. Some patients with early disseminated or secondary Lyme disease may not have any history of symptoms, tick bites, or skin rashes.

Lyme disease can affect the central nervous system and heart (cardiac system). Symptoms can come and go and may disappear after days, weeks, or months.

Symptoms include:

• Blurred vision
• Fainting
• Fatigue
• General discomfort, uneasiness, or ill feeling (malaise)
• Headache
• Heart palpitations
• Light-headedness
• Joint inflammation in the knees and other large joints
• Lethargy
• Muscle pains
• Stiff neck

Other symptoms that can occur with this disease:

• Abnormal sensitivity to light
• Confusion
• Decreased consciousness
• Drooping eyelids
• Dysfunctional movement
• Facial paralysis (also called Bell's palsy)
• Hallucinations
• Loss of muscle function and feeling
• Nausea and vomiting
• Numbness and tingling
• Speech impairment

A physical examination may show signs of nervous system (neurological) or heart problems.

Tests that may be done include:

• Chest x-ray
• ECG
• Echocardiogram
• ELISA test to screen for substances specific to the infection (in blood)
• Examination of cerebrospinal fluid
• MRI of the brain
• Western blot to confirm the presence of antibodies to Borrelia burgdorferi