Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: no known allergies / adverse drug reactions attending: chief complaint: headache and speech difficulties major surgical or invasive procedure: none history of present illness: 77 yo old right handed man who was transferred by from hospital after having an increasing headache while at home and finding an ich on ct scan. mr. states that he was talking with a friend and the friend was asking for money to borrow when he felt the gradual onset of a left frontal squeezing headache. the headache increased in intensity over the next few minutes until it was unbearable. he took his blood pressure at home and the systolic was 225. he had not noticed any associated symptoms at that time, no weakness, no difficulty speaking or understanding. he drove himself (around 10 miles) to . while in the ed he was documented as having difficulty understanding commands and was repeating questions such as "just tell me what you want me to do". he was taken to ct which noted a l temporo-parietal intraparenchymal hemorrhage and he was started on a cardene drip and medflighted to . his son and daughter-in-law arrived and said they thought he was initially dysarthric, but this has since improved. he has had a mild non-productive cough over the past few days. no fevers. he has had no recent changes in medications. on neuro ros, the pt had a headache, denies vertigo, tinnitus or hearing difficulty. has had difficulties producing and comprehending speech. denies focal weakness, numbness, parasthesiae. no bowel or bladder incontinence or retention. denies difficulty with gait. on general review of systems, the pt denies recent fever or chills. no night sweats or recent weight loss or gain. + cough, no shortness of breath. some chest tightness no palpitations. denies nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denies arthralgias or myalgias. denies rash. past medical history: hypertension atrial fibrillation - not on coumadin (unclear reason - attributes to possible r eye detached retina) cabg - bilateral hearing loss social history: lives in by himself. full adls and idls. worked in autobody work. non-smoker. no etoh family history: mother - gi cancer father - smoker - unknown cause of death son - healthy physical exam: admission assessment vitals: 98.3 83 142/72 16 spo2 98% ra general: awake, cooperative, nad. heent: nc/at neck: supple, no carotid bruits appreciated. no nuchal rigidity pulmonary: slight crackles at bases, good air entry cardiac: sternal scar, soft heart sounds, ii/vi sem abdomen: soft, nontender, nondistended extremities: mild edema of le to ankle, pulses palpated skin: no rashes or lesions noted. neurologic: -mental status: alert, oriented to w/ prompting, unable to get date, knew . able to relate history with some tangentiality. could do dow forward, not back.. language is nonfluent with frequent pausing, intact repetition to "today was a sunny day in " and comprehension "touch left hand to right ear". normal prosody. there were no paraphasic errors. pt. was unable to name any objects on the stroke card. alexia without agraphia, able to write "we came in a helicopter", but could not read a sentence. speech was not dysarthric. able to follow both midline and appendicular commands. pt. was able to register 3 objects and recall at 5 minutes. there was possibly apraxia with the right hand (more clumsy when asked to wave/salute). significant r visual field necglect versus hemianopia. -cranial nerves: i: olfaction not tested. ii: perrl 3 to 2mm and brisk. significant r visual field hemianopia v. neglect. funduscopic exam revealed no papilledema, exudates, or hemorrhages. iii, iv, vi: eomi without nystagmus. normal saccades. v: facial sensation intact to light touch. vii: no facial droop, facial musculature symmetric. viii: hearing intact to finger-rub bilaterally. ix, x: palate elevates symmetrically. : 5/5 strength in trapezii and scm bilaterally. xii: tongue protrudes in midline. -motor: normal bulk, increased tone in legs. no pronator drift bilaterally. mild intention tremor greater on the l hand noted. no asterixis noted. delt bic tri wre ffl fe io ip quad ham ta edb l 5 5 5 5 5 5 5 5 5 5 5 5 5 5 r 5 5 5 5 5 5 5 5 5 5 5 5 5 5 -sensory: no deficits to graphesthesia on the r hand or l. no deficits to light touch, pinprick, cold sensation, vibratory sense, proprioception throughout. extinction on the r to dss. -dtrs: tri pat ach l 1 1 1 1 0 r 1 1 1 1 0 plantar response was upgoing on the right and flexor on the left. -coordination: no intention tremor, no dysdiadochokinesia noted. no dysmetria on fnf or hks bilaterally. -gait: unable to test discharge exam: alert and oriented x2. anomic. full strength throughout. sensation intact to light touch, pinprick, vibratory sense, and proprioception. pertinent results: admission labs: 07:45pm blood wbc-10.4 rbc-5.35 hgb-16.3 hct-47.1 mcv-88 mch-30.5 mchc-34.7 rdw-13.0 plt ct-167 07:45pm blood pt-13.1 ptt-26.1 inr(pt)-1.1 07:45pm blood fibrino-368 07:45pm blood urean-12 creat-0.7 . other pertinent labs: 04:18am blood ck(cpk)-96 07:45pm blood lipase-25 04:18am blood ck-mb-4 ctropnt-<0.01 04:18am blood %hba1c-5.6 eag-114 04:18am blood calcium-8.7 phos-3.2 mg-1.7 cholest-132 04:18am blood triglyc-89 hdl-40 chol/hd-3.3 ldlcalc-74 07:45pm blood digoxin-0.5* 07:50pm blood glucose-102 lactate-2.2* na-139 k-4.0 cl-101 07:50pm blood freeca-1.11* 07:50pm blood po2-65* pco2-41 ph-7.38 caltco2-25 base xs-0 comment-green top . . urine: 08:00pm urine color-straw appear-clear sp -1.008 08:00pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.0 leuks-neg 08:00pm urine hours-random . . microbiology: mrsa screen mrsa screen-pending inpatient urine urine culture-pending . . chest (pa & lat) study date of 10:22 pm pa and lateral views of the chest: the patient is status post median sternotomy and cabg. the heart size is mildly enlarged and the aorta is tortuous. diffuse aortic calcifications are noted. pulmonary vascularity is normal, and the hilar contours are unremarkable. there is minimal atelectasis at the lung bases. no focal consolidation, pleural effusion or pneumothorax is identified. no acute osseous abnormalities are visualized. impression: minimal bibasilar atelectasis. . cta head/neck w&w/oc & recons study date of 10:40 pm ct: no significant interval change in left parietal/occipital lobe intraparenchymal hemorrhage, measuring up to 3.2 x 5.5 cm in the axial plane. new intraventricular hemorrhagic extension with minimal blood products layering in both occipital horns of the lateral ventricles. no midline shift or central herniation. no acute large vascular territorial infarction. cta head/neck: no evidence of large vessel occlusion, flow limiting stenosis, or aneurysm greater than 2mm involving the cervical or intracranial anterior or posterior arterial circulations. no arteriovenous malformation identified. dominant left vertebral artery with hypoplastic right vertebral artery. . ct head w/o contrast study date of findings: there is a large parenchymal hematoma involving the left posterior temporal, parietal and occipital lobes, which is not significantly changed in size. mild surrounding edema is unchanged in extent. there is slightly more blood in the occipital horns and atria of the lateral ventricles. the left occipital is compressed, as before. overall, the ventricles are stable in size. there is no shift of normally midline structures. multiple foci of low density are again seen in the subcortical, deep, and periventricular white matter, most suggestive of sequela of chronic small vessel ischemic disease in a patient of this age. intracranial arterial calcifications are again noted. the imaged portions of the paranasal sinuses and mastoid air cells are well aerated. impression: stable large left temporal/occipital/parietal parenchymal hematoma with slightly increased intraventricular extension. stable mass effect. . mri/mrv head w/o contrast study date of 11:18 am findings: again seen is a 5.2 (ap) x 2.8 cm (trv) intraparenchymal hemorrhage within the left temporoparietal regions. the overall size of the lesion appears unchanged from the prior exam. given the lobar distribution of the hemorrhage this is likely related to amyloid angiopathy. however, seen within the center of the lesion are multiple foci of enhancement with the largest measuring 0.7 x 0.6 cm (102b:42). although these are located centrally, it could be suggestive of active extravasation or enhancement of an underlying lesion such as a malignancy or avm. given that the surrounding flair hyperintensity does not involve the adjacent matter, an infarction would be less likely. evaluation of the mrv reveals no evidence for venous thrombosis. there is a hypoplastic left venous system, which, although not well visualized on the time-of-flight sequence, does opacify with contrast on the mp-rage sequence. blood is again seen within the occipital horns of the lateral ventricles but with no evidence for hydrocephalus. an incidental developmental venous anomaly is seen within the right parietal lobe. there is no shift of the normally midline structures seen and, other than the previously described lesion, there are no additional areas of abnormal enhancement or diffusion. the lenses and globes are normal. the visualized paranasal sinuses and mastoid air cells are well aerated. impression: 1. no evidence for venous thrombosis. 2. large left temporo-occipital intraparenchymal hemorrhage with central enhancing foci. again, this is suggestive of either active extravasation or enhancing underlying lesion. however, given the lobar distribution this appears to be sequela to amyloid angiopathy. followup is recommended. . . cardiology: portable tte (complete) done at 10:08:02 am conclusions the left atrium and right atrium are moderately dilated. no left atrial mass/thrombus seen (best excluded by transesophageal echocardiography).there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic arch is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets appear structurally normal. mild to moderate (+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is an anterior space which most likely represents a prominent fat pad. impression: mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. mild-moderate mitral regurgitation. pulmonary artery hypertension. dilated thoracic aorta. cerebral angiography: no avm or dural fistula noted. brief hospital course: 77 year old right handed man with htn, af not anticoagulated, cad with previous cabg () who presented with an acute headache w/ significant hypertension, found to have a l temporo-parietal iph on ct at an osh. on initial exam, he had significant aphasia, alexia w/out agraphia, complete anomia, with retained ability to follow commands and fluent but frequently halting speech. he had no agraphesthesia, sensory loss, and full motor strength throughout. on visual field exam, he was noted to have a right upper quadrantanopia, which was consistent with the location of his brain lesion. his blood pressures were significantly elevated on admission to neuro icu so he was started on iv nicardipine infusion. at this time, ct showed no significant interval change in the ich, which measured 3.2 x 5.5 cm in the axial plane with new intraventricular extension and dominant left vertebral artery with hypoplastic right vertebral artery. mri/mrv showed some contrast enhancemenet in the area of the bleed and mrv showed no venous sinus thrombosis. echo showed mild symmetric lvh with ef>55% and mild-moderate mr, evidence of pulmonary htn, a dilated 4cm thoracic aorta, and no evidence of atrial mass or thrombus. as he was stable, he was transferred to the stepdown unit on . he arrived on the floor in stable condition and converted to home meds. aspirin and s/c heparin were initially held given the risk of hemorrhagic expansion. soon after conversion to home meds, his blood pressure became difficult to control, requiring uptitration of his home mediations (lisinopril and metoprolol) and the addition of 5mg of amlodipine. this regimen was able to keep his sbp between 120-140. he also spiked a temperature of 100.9, prompting infectious workup involving blood cultures, urine cultures, and cxr all of which were unrevealing. on , he continued to have a low grade fever and appeared more somnolent, prompting a repeat ct which showed a stable hematoma with slight increase in intraventricular expansion. on he developed a right eye conjunctivitis, which was promptly treated with ciprofloxacin ophth soln with rapid improvement. this was thought to be the origin of his low grade fevers. otherwise, his infectious workup was unrevealing-- cxr x2 were negative, urine and blood cultures had no growth. he had a mild leukocytosis. he received at formal angiogram on which did not show any evidence of avm or dural fistula or aneurysm. his iph was thought to be the result of amyloid angiopathy. it is possible that it is the result of hypertension. clinically, over the course of hospital stay, his speech improved but he persisted in having marked expressive aphasia and anomia. he was evaluated by speech/swallow and was found to tolerate regular foods. pt and ot also evaluated him and found him to be ataxic and therefore recommended rehabilitation. on discharge to rehab, mr. was in good condition and seemed to be in high spirits. his son, however, notes that his father has poor insight into his condition and reports a history of steady decline marked by a significant loss of physical ability. as mr. currently lives alone, his son is currently consider and other options after rehabilitation. = = = = = = = = = = = = = = = = = = = ================================================================ transitional issues: 1. intraparenchymal bleed: thought amyloid angiopathy. he was started on low dose aspirin given his stable condition. he he was to worsen clinically, further imaging should be performed to rule out further bleeding. he will have neurology follow up at . 2. htn: he had difficult to control bp post- stroke requiring uptitration of his bp meds and addition of amlodipine. he might require further titration of these meds (either up or down) in the near future. 3. intermittent low grade temperature/ mild leukocytosis: he had conjuctivitis which was treated with ciprofloxacin drops. he had no clear source of infection with negative blood cultures/negative urine cultures/negative cxr. if he continues to be afebrile, he will require further workup for infectious etiologies. medications on admission: metoprolol 25 mg pravastatin 10 mg daily digoxin 0.125 mg daily aspirin 81 mg daily lisinopril 10 mg daily discharge medications: 1. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 2. pravastatin 20 mg tablet sig: 0.5 tablet po daily (daily). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 4. docusate sodium 100 mg capsule sig: capsules po bid (2 times a day). 5. insulin regular human 100 unit/ml solution sig: as directed injection asdir (as directed). 6. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain/fever. 7. lisinopril 10 mg tablet sig: three (3) tablet po daily (daily). 8. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 9. ciprofloxacin 0.3 % drops sig: two (2) drop ophthalmic q4h (every 4 hours): please continue for 5 more days until . 10. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 11. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). discharge disposition: extended care facility: discharge diagnosis: left parieto-occipital intraparenchymal hemorrhage likely secondary to amyloid angiopathy discharge condition: alert unable to ambulate without assistance unchanged aphasia discharge instructions: take all of your medications as directed. do not stop or change any of your medications without first speaking to your doctor. if you experience any severe headaches, fevers, chills, or any other concerning symptoms seek medical attention immediately. followup instructions: department: neurology when: tuesday at 10:30 am with: , md building: campus: east best parking: garage md, procedure: arteriography of femoral and other lower extremity arteries arteriography of cerebral arteries diagnoses: unspecified essential hypertension atrial fibrillation aortocoronary bypass status intracerebral hemorrhage unspecified hearing loss aphasia visual field defect, unspecified other amyloidosis conjunctivitis, unspecified other symbolic dysfunction unspecified cerebrovascular disease 

Answer: The patient is high likely exposed to