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 the present illness: the patient is a 58-year-old male with a past medical history for vasovagal syncope status post pacemaker placement in , pacemaker removal in secondary to infection, who presents with an episode of syncope while urinating. the patient was in his usual state of health when he awoke at 5:00 a.m. this morning to urinate. he found that he had difficulty getting up because of his left leg weakness. his wife noted that he was able to walk but had slurring of speech. he went to the bathroom where he experienced roughly one minute of unresponsiveness. per the report of his wife, there was no seizure activity, no urinary or bowel incontinence, no biting of tongue. he went back to sleep and woke up at 8:00 a.m. without his leg weakness, normal speech, but tingling sensations persisted. he presented to the ed and was essentially asymptomatic. the vital signs were stable. review of symptoms were negative. in the emergency room, he was evaluated by neurology who felt that he had a transient ischemic attack versus seizure. during workup, there was an observed episode of slurred speech, left facial, arm, and leg tingling. on evaluation, the blood pressure was 121/76, heart rate 50. he had left facial weakness with only a mild left hemiparesis with ataxia out of proportion to his weakness that lasted 15 minutes and resolved. the vital signs remained stable. the cta was negative for acute intracranial bleeding or abscess. the patient states that he was continued on his normal dose of dilantin 200 mg p.o. b.i.d. for seizure prophylaxis secondary to an avm repair in . the patient and the pcp report five such episodes of left-sided weakness, tingling, and dysarthria have occurred since pacemaker implantation, although current episode of syncope was void of such symptoms. denied fevers, chills, anesthesia, illness, lightheadedness, visual changes, postictal state, chest pain, nausea, vomiting. past medical history: 1. as above, a pacemaker, single-chamber, inserted in for vasovagal syncope which was explanted in secondary to cellulitis. 2. avm resection in . the patient was on dilantin and phenobarbital from to for seizure prophylaxis, was taken off aeds in , recently restarted on dilantin three weeks ago. 3. gout, last flare in with right metatarsal head inflamed, currently stable. 4. hypertension. 5. hypercholesterolemia. admission medications: dilantin 200 mg p.o. b.i.d. allergies: codeine. family history: no history of stroke or seizure. positive for chronic atrial fibrillation in a younger brother. maternal grandmother has type 2 diabetes, no cad, colon cancer, skin cancer. social history: the patient is a self-employed contractor. denied smoking, drugs. occasional alcohol use. no substance abuse. physical examination on admission: vital signs: the patient was afebrile at 97, heart rate 59, blood pressure 173/85. orthostatics checked on the floor were negative, breathing at a rate of 16, 98% on room air. heent: nc/at, mmm, perrla, eomi, fields full, no nystagmus. neck: supple. no adenopathy. no carotid bruits appreciated. cardiac: regular rate, no murmurs, rubs, or gallops. lungs: clear to auscultation bilaterally. abdomen: soft, nontender, nondistended, normoactive bowel sounds. extremities: no clubbing, cyanosis or edema. capillary refill less than two seconds. neurologic: mental status-alert and oriented times three. speech appropriate, fluent, naming and repetition intact, comprehension intact. cranial nerves ii through xii without deficits. tongue midline. palate elevation normal. face symmetric. motor: no tremor. normal bulk, tone. no pronator drift, midline. strength was symmetric and full on both sides. sensory: intact to light touch, pinprick, temperature, vibration, and proprioception. reflexes were 3+ in the right upper extremity, 3+ in the left upper extremity, 3+ right lower and left lower extremities. the toes were downgoing bilaterally. coordination: finger-to-nose no ataxia, rapid finger tapping intact bilaterally. gait: romberg negative, narrow base stance. no difficulty with tandem gait. laboratory/radiologic data: pertinent for a creatinine of 1.1 which is his baseline, glucose 103, calcium 8.7, phosphorus 3, magnesium 2. ck troponin negative. tsh 2.7. homocysteine 14. triglycerides 326, hdl 42, ldl 190. white count 6.3, hematocrit 42, platelets 179,000. prothrombin time 11, partial thromboplastin time 25. the patient had a cta and could not undergo mri due to right craniotomy clips as well as retained ventricular pacing wire. no evidence of acute intracranial hemorrhage. scattered calcifications in the left internal carotid and left vertebral body with mild midbasilar narrowing, no aneurysm identified. ekg showed sinus bradycardia, borderline left axis deviation, rsr pattern in v1 with normal qrs duration. the patient's workup for both presentations of syncope and observed in the emergency room with stable vital signs. the stroke team, cardiology, electrophysiology, and neurosurgery were consulted for appropriate workup. the patient remained on telemetry and the vital signs were stable throughout. an eeg had been performed prior as an outpatient which was negative for seizure which was low on the differential. tee and tte with bulbar study were negative for asd or pfo. it was felt that this was less likely to represent embolic phenomenon. carotid ultrasounds were negative. it was felt that angiography would be the best to apprise posterior circulation. angiography was performed by dr. which revealed a stenosis of the left vertebral artery at its origin as well as a midbasilar stenosis of approximately 70-80%. at that time, the decision for intervention was made on the left vertebral artery on the basis of providing the most flow to the already stenotic basilar lesion. hospital course: the patient was started on aspirin, plavix, as well as risk factor modification with b12, b6, and folate administered due to elevated homocysteine. lipitor was started given prior elevated lipid panel. the patient underwent uncomplicated stenting of the origin of the left vertebral artery with good distal flow, no focal neurologic deficit. the patient remained free of syncopal and dysarthria, left-sided weakness, or neurologic sequelae throughout. in discussion with cardiology and neurology, at this time, episodes likely represent dual episodes of vasovagal syncope and tia. transient ischemic attacks are being addressed with antiplatelet therapy of aspirin and plavix as well as decreasing lipid profile and addressing homocysteine elevation. if the patient experiences further vasovagal episodes, this would warrant implantation of the pacer. it was felt that pacemaker placement right now was not sufficient enough to fully address his known basilar stenosis. at this time, the risks and benefits were in favor of holding pacemaker placement and continue with a trial of medical management and observation post left vertebral stenting. discharge medications: 1. dilantin 100 b.i.d. this is to be tapered per pcp until off as no history nor likelihood of seizure disorder. 2. aspirin 325 mg p.o. b.i.d. 3. plavix 75 mg p.o. b.i.d. 4. folic acid one tablet p.o. q.d. 5. vitamin b12 and b6 p.o. q.d. 6. lipitor 10 mg p.o. q.d. pending further lft checks. statin dose should be maximized given the patient's severe atherosclerotic risk. follow-up: the patient is to follow-up in one to two weeks with dr. , his pcp, appraise neurologic examination, monitor for signs of further syncopal episodes and/or tia episodes. possible initiation of low-dose ace inhibitor if blood pressure and heart rate stable. disposition: the patient was discharged to home in stable condition without neurologic deficits on antiplatelet therapy post stenting of the left vertebral artery. dictated by: medquist36 procedure: diagnostic ultrasound of heart angioplasty of other non-coronary vessel(s) insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) diagnoses: pure hypercholesterolemia unspecified essential hypertension occlusion and stenosis of vertebral artery without mention of cerebral infarction other convulsions other specified cardiac dysrhythmias sinoatrial node dysfunction unspecified transient cerebral ischemia 

Answer: The patient is high likely exposed to