Brief Answer:
She will need to be seen by a doctor to rule out brain lesions, including neurological Lyme disease

Detailed Answer:
Hello and welcome to 'Ask A Doctor' service,

I carefully read your query and understand your concern.

Most of the patients that get Lyme disease (from a tick bite) do develop a rash but unfortunately, there are a few that do not.

In the first stage of the disease patients may develop some flu-like symptoms (cold-like symptoms). Later other organs may get affected, joints in the majority of times but in some cases, the brain may be affected.

I would recommend your wife to see a doctor urgently and have a full neurological exam. According to the findings, the doctor may order a brain MRI (if abnormalities are noticed), a lumbar puncture, and also ELISA blood tests for Borrelia Burgdoriferi (if a few weeks have passed from the bite).

If the doctor highly suspects Lyme disease he may decide to start her on treatment before the results of the tests are available.

To conclude:

- A tick bite may impose the risk for Lyme disease and the presence of flu-like symptoms soon after and neurological signs (asymmetrical pupils) warrant a visit with the doctor soon to have a thorough examination and probably blood tests and brain scans to rule out/in Lyme disease (from Borrelia Burgdoriferi)

- Any neurological sign (asymmetrical pupils as well) warrant a visit with the doctor even in the absence of the history of a tick bite and the brain MRI will help rule out other possible lesions in the brain that may cause the pupils to be asymmetrical (tumors)

I hope this answers your query.
I remain at your disposal in case further medical assistance is needed.

Regards,

Dr. Antoneta Zotaj,
General and Family Physician

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