Forth Installment: Checklist of Symptoms

This is a questionnaire Dr. Burrascano developed over the years, and I think you will be amazed at how many symptoms can be associated with Lyme disease. This outline is designed to help the physician in his or her interview of the patient to clarify symptoms and diagnosis which will then lead to the ability to establish a protocol for treatment. Here it is:

Have you had any of the following in relation to this illness? (CIRCLE “NO” OR “YES”)

Tick bite No/ Yes

“Erythema Migrans” rash ( a discrete circle) No/ Yes

Spotted rash over large area No/ Yes

Linear, red streaks No/ Yes


SYMPTOM OR SIGN (Answer the following questions by indicating the following: NONE, MILD, MODERATE, SEVERE, NOT APPLICABLE; NEVER, OCCASIONAL, OFTEN, CONSTANT):

  • Persistent swollen glands
  • Sore throat
  • Fevers
  • Sore soles or heels, especially in the mornings
  • Joint pain
  • Fingers, toes pain
  • Ankles, wrists pain
  • Knees, elbows pain
  • Hips, shoulders pain
  • Joint swelling
  • Fingers, toes swelling/pain
  • Ankles, wrists swelling/pain
  • Knees, elbows swelling/pain
  • Hips, shoulders pain
  • Unexplained back pain
  • Stiffness of the joints or back
  • Muscle pain or cramps
  • Obvious muscle weakness
  • Twitching of the face or other muscles
  • Confusion, difficulty thinking
  • Difficulty with concentration, reading, problem absorbing new information
  • Word search, name block
  • Forgetfulness, poor short term memory, poor attention
  • Disorientation: getting lost, going to wrong places
  • Speech errors- wrong word, misspeaking
  • Mood swings, irritability, depression
  • Anxiety, panic attacks
  • Psychosis (hallucinations, delusions, paranoia, bipolar)
  • Tremor
  • Seizures
  • Headache
  • Light sensitivity
  • Sound sensitivity
  • Vision: double, blurry, floaters
  • Ear pain
  • Hearing: buzzing, ringing, decreased hearing
  • Increased motion sickness, vertigo, spinning
  • Off balance, “tippy” feeling
  • Lightheadedness, wooziness, unavoidable need to sit or lie
  • Tingling, numbness, burning or stabbing sensations, shooting pains, skin hypersensitivity
  • Facial paralysis-Bell’s Palsy
  • Dental pain
  • Neck creaks and cracks, stiffness, neck pain
  • Fatigue, tired, poor stamina
  • Insomnia, fractionated sleep, early awakening
  • Excessive night time sleep
  • Napping during the day
  • Unexplained weight gain
  • Unexplained weight loss
  • Unexplained hair loss
  • Pain in genital area
  • Unexplained menstrual irregularity
  • Unexplained milk production; breast pain
  • Irritable bladder or bladder dysfunction
  • Erectile dysfunction
  • Loss of libido
  • Queasy stomach or nausea
  • Heartburn, stomach pain
  • Constipation
  • Diarrhea
  • Low abdominal pain, cramps
  • Heart murmur or valve prolapse
  • Heart palpitations or skips
  • “Heart block” on EKG
  • Chest wall pain or ribs sore
  • Head congestion
  • Breathlessness, “air hunger”, unexplained chronic cough
  • Night sweats
  • Exaggerated symptoms or worse hangover from alcohol
  • Symptom flares every 4 weeks (called a Herxheimer reaction)


“It is important to note that the Center for Disease Control’s published reporting criteria are for surveillance only, not for diagnosis. They should not be misused in an effort to diagnose Lyme or set guidelines for insurance company acceptance of the diagnosis, nor be used to determine eligibility for coverage.”

For anyone familiar with attempting to either treat or receive treatment for Lyme disease this is a very important statement, and is critical information for treating physician and patient alike. The so-called “Lyme controversy” circles (at least is part) around the difficulty of reaching a reasonable diagnosis with these tick born diseases. Burascanno and associates offer a productive as well as practical approach to the sticky problem of diagnosis (and therefore the treatment) of Lyme disease.

This document aids the clinician by developing a prioritized set of diagnostic criteria; it was developed with the input of dozens of front line physicians and was developed over many years. It creates a relative value in relation to different factors. From the cumulative number it can then be predicted whether Lyme Borreliosis is highly likely, possible or unlikely. The following is a listing of the criteria and their relative values:


  • Tick exposure in an endemic region: 1
  • Historical facts and evolution of symptoms over time consistent with Lyme: 2
  • Systemic signs & symptoms consistent with Bb infection (other potential diagnoses excluded):
  1. Single system, e.g., monoarthritis: 1
  2. Two or more systems, e.g., monoarthritis and facial palsy: 2
  • Erythema migrans, physician confirmed: 7
  • (Acrodermatitis Chronica Atrophicans), biopsy confirmed: 7
  • Seropositivity (positive blood test results): 3
  • Seroconversion on paired sera: 4
  • Tissue microscopy, silver stain: 3
  • Tissue microscopy, monoclonal immunofluorescence: 4
  • Culture positivity: 4
  • B. burgdorferi antigen recovery : 4
  • B. burgdorferi DNA/RNA recovery: 4


Lyme Borreliosis Highly Likely: 7 or above
Lyme Borreliosis Possible: 5-6
Lyme Borreliosis Unlikely: 4 or below

Dr. Burascanno suggests that when using these criteria, you state Lyme Borreliosis is “unlikely”, “possible”, or “highly likely” based upon the following criteria”- then list the criteria.

This is actually a revolutionary approach to the diagnosis of Lyme disease and could facilitate a rational approach to this devastating illness.

As you can see some of this criteria is technical and for our purposes the details of some of these tests are better left in the hands of physicians and laboratories. However, let it be said that patient knowledge and self-advocacy is critical to obtain the best diagnosis and treatment of whatever condition/s we have; this site is dedicated to your ability to work consciously with your treatment providers for optimum health and well-being.