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: penicillins attending: chief complaint: acute onset of l sided weakness major surgical or invasive procedure: tpa history of present illness: 79 year old right handed male with history of afib, lymphoma, and hx of gi bleed from coumadin in , who awoke well this am at 7:30. at 8:30 am wife found him on the ground in the kitchen and when she found him he had slurred speech and l sided weakness. brought immediately to ed. patient says that about 15 min prior to his wife finding him he slumped to the ground b/c he felt weak. denies any head trauma, loc or confusion. remembers the whole event. ros (taken briefly from wife) negative for recent illness, travel, fever, medication changes, head trauma. past medical history: -a fib, had been on coumadin but sustained multiple systemic bleeds including large gi bleed in , so off all anti-platelets or anti-thrombotics -hx of mantle cell lymphoma treated with five cycles of r-chop,in remission. -recent perianal lymph node biopsy for ? lymphoma (uptake on recent pet scan) on with complication of urinary retention. -reflux, which is likely largely due to bile reflux given his past history of a vagotomy and partial gastric resection. meds: protonix folate flomax vitamin b12 social history: quit tobacco 30years ago (10 pack year hx) few beers daily no illicit drug abuse has 6 children, lives with wife retired gas serviceman/car inspector family history: mother -cva, htn father - died of heart condition physical exam: pe: vitals: afebrile, hr 84, bp 120/66 gen: awake, in no distress heent: mmm, op benign neck: supple, no bruits cv: irregularly irregular rhythm, no murmur resp: cta b abd: soft, nt/nd ext: warm, well perfused skin: no rash ms: awake and alert, oriented to name and place, interactive and appropriate. fluent, comprehends, dysarthric. intact to repetition and naming high frequency objects. no left-right confusion. cn: perrla, vfftc, optic disks sharp, no papilledema or hemorrhages. eomi without nystagmus but seems to bury less completely on the l, no ptosis. sensation intact to lt/pp, masseters strong symmetrically. corneal reflex present. l facial weakness in umn pattern. voice normal, palate symmetric, gag intact. ss bilaterally. tongue midline, no atrophy or fasciculation. motor: nl bulk and tone, no tremor, rigidity or bradykinesia. l pronator drift. l side: deltoid, tricep, we, hf, foot dorsiflexion , otherwise r side throughout reflexes: tri br pat ach plantar l 2 2 2 2 2 down r 2 2 2 2 2 down : + extinction to dss on l. nihss 7 pertinent results: 03:12pm ck(cpk)-131 03:12pm ck-mb-3 ctropnt-<0.01 11:00am urine color-straw appear-clear sp -1.033 11:00am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg 09:39am glucose-128* urea n-9 creat-0.7 sodium-136 potassium-4.1 chloride-100 total co2-27 anion gap-13 09:39am wbc-2.4* rbc-3.59* hgb-9.1* hct-28.1* mcv-78* mch-25.3* mchc-32.3 rdw-16.9* 09:39am pt-11.9 ptt-26.3 inr(pt)-1.0 09:39am plt count-265 05:17pm blood gastrin-pnd 03:00pm blood protcfn-74 protcag-pnd protsfn-64 protsag-pnd 07:22am blood wbc-5.1 rbc-3.82* hgb-10.0* hct-30.2* mcv-79* mch-26.3* mchc-33.3 rdw-16.8* plt ct-269 07:22am blood plt ct-269 : vit-b12:802 folate:>20 psa:6.4 comments: measured by elecsys (eclia) other blood chemistry: caltibc: 499 ferritn: 10 trf: 384 triglyc: 39 hdl: 84 chol/hd: 2.3 ldlcalc: 97 ldl(calc) invalid if trig>400 or non-fasting sample other hematology ret-aut: 1.9 initial cta: findings: there is no evidence of acute intracranial hemorrhage on non- contrast ct study. no shift of normally midline structures. note is made of somewhat dilated and symmetric ventricles bilaterally. on ct angiography, note is made of occlusion of proximal m2 segment of right mca just at the bifurcation. note is made of anterior temporal branch of mca arising from m1. no anterograde flow is seen from right mca bifurcation. distally, sylvian branches are filled, probably due to collateral circulation. slight paucity of the vessels is seen in posterior right temporal lobe. the other major branches of intracranial vessels show normal enhancement. on perfusion mapping, note is made of slight decrease in perfusion in posterior temporal lobe on the right. multiplanar reformation images confirm the above finding. impression: occlusion of proximal m2 segment of the right mca at bifurcation, without evidence of anterograde flow. no evidence of infarction visible on non-contrast ct within brain parenchyma, however, there is slight perfusion decrease in right posterior temporal lobe. the information was communicated with the stroke fellow taking care of the patient in person at the time of examination, approximately at 10:30, and wet read was provided through ccc to ed dashboard. ekg: atrial fibrillation with a controlled ventricular response. since the previous tracing of ventricular premature beat is no longer seen. cxr: upright ap view of the chest: heart is mildly enlarged. mediastinal and hilar contours are unchanged. pulmonary vascularity is within normal limits. the lungs are clear. there are no focal consolidations, pleural effusions, or pneumothorax. the osseous structures are unremarkable. impression: mild cardiomegaly. no acute cardiopulmonary abnormality. mri: findings - brain mri: the diffusion images demonstrate slow diffusion in the right frontal lobe and subinsular region and the right temporal lobe consistent with acute infarct in the distribution of right middle cerebral artery. there is moderate brain atrophy seen. no evidence of midline shift, mass effect, or hydrocephalus identified. no evidence of acute or chronic blood products seen. susceptibility images demonstrate an area of low signal in the region of bifurcation of the right middle cerebral artery suggestive for a thrombus. impression: acute right middle cerebral artery territorial infarct involving the frontal, temporal, and subinsular regions of the right cerebral hemisphere. probable thrombus in the bifurcation region of right middle cerebral artery. no acute hemorrhage or mass effect. mra of the head: the head mra demonstrates narrowing of the flow signal in the lateral portion of the m1 segment of the right middle cerebral artery with diminished flow signal in the sylvian branches of right middle cerebral artery consistent with a thrombus in the middle cerebral artery. the remaining arteries of anterior and posterior circulation demonstrate normal flow signal. compared to the prior cta, there appears to be some increased flow within the region of the right mca bifurcation. impression: there appears to be improved flow within the right middle cerebral artery compared to the cta. however, there is persistent decreased flow signal in sylvian branches of the right middle cerebral artery secondary to thrombus in the mca. no other abnormalities on the mra of the head. eeg: findings: abnormality #1: there is intermittent right frontal central slowing in the 2 hz delta frequency range. abnormality #2: the background is slow in the 7 hz theta frequency range and those in the entire right hemisphere was mildly disorganized and shows some increased voltage gradient. background: as above. hyperventilation: could not be performed due to the patient's clinical condition. intermittent photic stimulation: produced no activation of the record. sleep: this study shows wakefulness progressing to drowsiness. cardiac monitor: an irregular heart beat at the rate of 60 bpm. occasionally there are brief beat pauses up to 1.5 seconds. impression: this is an abnormal routine eeg obtained in wakefulness progressing to drowsiness due to the presence of intermittent right frontal central slowing in the delta frequency range and slow and mildly over the right hemisphere disorganized background rhythm. this abnormality suggests deep, midline subcortical dysfunction consistent with a mild encephalopathy. the first abnormality is suggestive of subcortical dysfunction over the right frontal temporal region. there were no clear epileptiform abnormalities recorded. there was an irregular heart beat noted. echo: conclusions: the left atrium is markedly dilated. the right atrium is markedly dilated. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. no intracardiac thrombus seen.the right ventricular cavity is mildly dilated. right ventricular systolic function is normal. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. compared with the prior study (images reviewed) of , the rv cavity size looks slightly larger. otherwise, no change. impression: no cardiac source of embolism identified. if clinically indicated, a tee would better exclude a possible source of embolism. gi bx 1 distal esophagus: distal esophagus, mucosa, biopsy: squamous epithelium with mild active esophagitis. egd findings : -small hiatal hernia, displacing z-line to 37 cm from incisors, with narrowing at 40 cm from the incisors -grade 4 esophagitis with spontaneous bleeding in the middle third of the esophagus, lower third of the esophagus and ge jxn. bx taken (above) -evidence of previous partial gastrectomy with bilroth ii seen -diffuse erythema and congestion of the mucosa of the stomach with no bleeding -single 4 mm nonbleeding nodule at the gj anastomosis site -gastric ph was 5 - low - raises question of retained antrum syndrome -rec: ppi, carafate 1 g qid -normal duodenum brief hospital course: this is a 79 year old man with atrial fibrillation and history of gi bleeds in the past, who had presented with slurred speech and left arm weakness, who was brought to and received tpa at 3 hours after onset of symptoms (11am) following cta that revealed occlusion or tight stenosis of right mca approximately at the bifurcation. also noted on cta were enhancement of peripheral small vessels, likley to be collaterals, and on perfusion mapping, note was is made of slight decrease in perfusion in posterior temporal lobe on the right. (please see "results" section for further details on studies.) the stroke was likely to be cardioembolic considering his history. he was admitted to the icu following tpa for close monitoring; blood pressure autoregulated and after 24 hours, aspirin was recommended, which he refused given his gi bleed history (including a large gi bleed following aspirin use). exam improved and he was transferred to the floor. his exam continued to improve, and at discharge, he had mild dysarthria and subtle left finger extensor weakness alone. as coumadin had also caused gi bleeding in the past, gi was consulted for further management considering this history of bleeding, and with the question of whether aspirin would be better or worse than coumadin with regards to gi bleed risk. he was transfused for a drop in hct, and underwent endoscopy, which revealed gastritis and esophagitis (see "results" section), with low gastric ph, raising the possibility of retained antrum syndrome following a billroth ii operation. a gastrin level was sent and was still pending at discharge. ppi and qid carafate were recommended, and gi felt that part of his history of gi bleeds related to medication noncompliance with protective and acid-reducing medications. they also felt that coumadin and aspirin had approximately equivalent risks of gi bleed. the risks and benefits of the medications were explained to the patient, an in the end, with equivalent risk profiles and coumadin providing better protection from another cardioembolic event considering his embolic infarct and atrial fibrillation, coumadin was started after protein c and s panels were sent (results of which were pending at discharge, but appear to be normal). he was advised of the importance of continuing his gi medications. he was set up with the coumadin clinic to follow his inr on this medication, with the goal inr being the narrow range of .5 in order to protect him as much as possible from both gi bleed and stroke. medications on admission: protonix folate flomax vitamin b12 discharge medications: 1. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 3. sucralfate 1 g tablet sig: one (1) tablet po qid (4 times a day). disp:*120 tablet(s)* refills:*2* 4. warfarin 2.5 mg tablet sig: two (2) tablet po at bedtime: please check inr on friday, ; call for instructions (coumadin clinic). disp:*60 tablet(s)* refills:*2* 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* -flomax, b12 and folate should be restarted as an outpatient discharge disposition: home discharge diagnosis: cerebral infarction - r mca discharge condition: good - exam with left facial droop, very mild left hand extensor weakness, and mild dysarthria. discharge instructions: please md or return to ed if you experience new sx suggestive of stroke. please check inr on on , ; follow up with coumadin clinic for further instructions () followup instructions: please call for neurology appointment with drs. and in weeks. provider: , md phone: date/time: 9:30 provider: , md phone: date/time: 1:30 provider: , md phone: date/time: 11:00 procedure: injection or infusion of thrombolytic agent esophagogastroduodenoscopy [egd] with closed biopsy transfusion of packed cells diagnoses: atrial fibrillation other malignant lymphomas, unspecified site, extranodal and solid organ sites iron deficiency anemia, unspecified cerebral embolism with cerebral infarction esophagitis, unspecified diseases of tricuspid valve 

Answer: The patient is high likely exposed to