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: history of present illness: the patient is a 52-year-old right-handed woman with a history of hypertension and hypercholesterolemia, who presented with headache, difficulty speaking, and right-sided weakness. the patient began to complain of left ear pain and a left sided throbbing headache approximately three days prior to admission. she had made an appointment with her primary care physician to followup on these issues. on the day of admission, she was dropped off by her son at 2:30 p.m. at her physician's office. she was able to ask her son to drop her off and tell him to go park the car at a parking meter. she was found in the waiting room by her primary care physician 2:45 p.m. to be slumped over and not able to speak. she was also drooling at that time. she was transferred to the emergency department at that time. the stroke service was quickly activated. past medical history: 1. hypertension. 2. hypercholesterolemia. 3. obesity. 4. history of c sections. medications on admission: 1. aspirin 325 mg p.o. q.d. 2. zestril. 3. lipitor. allergies: reported as penicillin and sulfa. social history: patient is not a current smoker. she denied alcohol use. she is a second grade teacher and has two children. family history: relevant for relatives with strokes including her father with onset their 50s to 60s. physical exam on admission: temperature 97.8, blood pressure 137/74, respiratory rate 19, and oxygen saturation 94%. in general, she was well appearing in no apparent distress. her mucous membranes are moist. her lungs were clear. there were no carotid bruits. heart was regular without murmurs, rubs, or gallops. her abdomen was benign. extremities showed no edema. on mental status testing, she was alert. she was unable to say her name or repeat many words. she was not able to follow commands. on cranial nerve testing, the visual fields appeared full on blink to threat. her extraocular movements were intact. pupils are equal, round, and reactive to light. there was a right facial droop. hearing was intact. the palate rose midline. sternocleidomastoid and trapezius muscles were strong. tongue was midline. on motor testing, she had antigravity strength in the right arm, but had a pronator drift. the other limbs appear to have normal strength. sensation was intact to pain in all four extremities. reflexes were symmetric. toes were downgoing. coordination and gait were not tested. head ct on arrival showed no evidence of intracranial hemorrhage or infarction. laboratory results on admission: white blood cell count 7.1, hematocrit 42.4, platelets 196. sodium 141, potassium 4, chloride 103, bicarb 26, bun 19, creatinine 0.7, glucose 105. ck 66. pt 11.9, ptt 25.4. ekg showed sinus tachycardia without any other abnormalities. impression at time of admission: this was a 52-year-old woman with hypertension and hypercholesterolemia with global aphasia and right-sided hemiparesis consistent with left mca acute stroke. hospital course by systems: 1. neurology: as there was no evidence of hemorrhage and the patient presented within the time frame, she was given intravenous tpa. angiogram was considered for further vessel imaging, but this was not performed. she was admitted to the neuro intensive care unit for close neurologic monitoring. all antiplatelet anticoagulants were held for 24 hours. she was then started on aspirin at 24 hours out from the tpa. a mri/mra on hospital day #2 was limited as diffusion imaging was not performed. however, it did show a tiny focus of hyperintensity in the left posterior frontal lobe on the flare images. on the mra, there was no flow identified in the cervical internal carotid artery, which appeared to be occluded just distal to its origin. there is an abrupt tapering of the internal carotid artery at its origin. it was unclear whether the findings were consistent with dissection versus a small amount of flow into the proximal vessel. followup head ct as well on hospital day #2 showed interval evolution of the infarct now clearly visible in the left frontal lobe with extension into the anterior aspect of the insula and possibly into the left temporal lobe. there was no signs of hemorrhage. after the patient was stable, she was transferred to the regular neurology floor. her aspirin was changed briefly to aggrenox. however, on follow-up mri performed on , this showed an irregularity in the petrous portion of the left internal carotid artery. axial t1 fat saturated images showed increased signal surrounding the vessel consistent with dissection of the left internal carotid artery. the mri showed subacute infarct in the left hemisphere involving the posterior frontal lobe, temporal lobe, and portions of the parietal lobe. due to the dissection, the patient was changed to heparin with a goal ptt between 45 and 65. her ptts were followed closely and were higher than the goal range, and therefore were adjusted accordingly. therefore, the most likely diagnosis is a left internal carotid artery dissection leading to occlusion with subsequent strokes in the left mca territory distribution. she will be on heparin, then transition to coumadin with a goal inr between 2 and 2.5. she will follow up with dr. in clinic and will most likely need further followup of vessel imaging to determine the length of anticoagulation. other stroke workup was performed. transthoracic echocardiogram showed an ejection fraction of greater than 60%. there was no asd or pfo. the left atrium was normal in size. carotid ultrasounds showed no stenosis in the right internal carotid artery. the findings on the left were consistent with a more distal occlusion versus stenosis in the intracranial portion of the left internal carotid artery, which was confirmed on the mra. lipid profile was checked and was normal, and the patient was continued on lipitor. esr and homocysteine were normal. was negative. further laboratories that are pending at this time that need to be followed up on include a lupus anticoagulant, anticardiolipin antibody, then alpha-1 antitrypsin. patient received physical therapy, occupational therapy, and speech therapy throughout her stay, and will need to continue these at rehab. 2. cardiovascular: the patient had one set of negative cardiac enzymes. her echocardiogram is as above. she had no significant cardiovascular issues during this admission. 3. respiratory: no significant issues. 4. gi: the patient was maintained on pepcid for gi prophylaxis. 5. heme: the patient's hematocrit slowly decreased over the course of admission and then was stable. the most recent was 32.6. this will need to be followed. stools were guaiac negative. her platelet count also slowly decreased from 196 on admission to 147 on the day of transfer, and this will also need to be followed. 6. fluids, electrolytes, and nutrition: patient was maintained on normal saline at 100 cc/hour. she did pass her swallow evaluation and was cleared for nectar-thick liquids and soft solids. she was cleared for taking her pills whole with thick liquids. she should be maintained on aspiration precautions. in summary, patient is a 52-year-old woman with hypertension and hypercholesterolemia, who presented with headache, aphasia, and right-sided weakness, who is found to have left mca territory stroke subsequent to a left internal carotid artery dissection. she will be anticoagulated for the dissection. her neurologic exam at discharge is notable for nonfluent speech with impaired naming. her repetition was intact. she was able to sing quite well. her extraocular movements were intact. she continued to have a right facial droop. there was a decreased tone in the right side with a right hemiparesis. strength in the left side was normal. sensation was decreased to light touch on the right compared to the left. her right toe was upgoing. most recent laboratories: white blood cell count 6.6, hematocrit 32.6, platelets 147. sodium 144, potassium 3.7, chloride 112, bicarb 23, bun 18, creatinine 0.6, glucose 97. ptt 93.2, inr 1.2. discharge condition: stable. discharge status: to . diagnoses: 1. left frontal, temporal, and parietal stroke. 2. left internal carotid artery dissection. 3. hypertension. 4. hypercholesterolemia. 5. obesity. discharge medications: 1. heparin 600 units/hour with goal ptt between 45-65. ptt should be followed q.6h. until therapeutic and then q.12h. the heparin should be continued until her inr is therapeutic between 2 and 2.5. 2. coumadin 2.5 mg p.o. q.h.s. dose adjusted for inr goal between 2 and 2.5. 3. famotidine 20 mg p.o./ng b.i.d. 4. atorvastatin 10 mg p.o. q.d. 5. tylenol 325-650 mg p.o. q.4-6h. prn pain. , m.d. dictated by: medquist36 procedure: injection or infusion of thrombolytic agent diagnoses: pure hypercholesterolemia unspecified essential hypertension dissection of carotid artery obesity, unspecified occlusion and stenosis of carotid artery with cerebral infarction 

Answer: The patient is high likely exposed to