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: patient recorded as having no known allergies to drugs attending: chief complaint: dizziness, left-sided weakness and clumsiness major surgical or invasive procedure: cerebral angiography history of present illness: 59 year-old right-handed man with no significant history is transferred from with 2 days of progressive dizziness, left hemiparesis and ataxia. pt reports that on sunday he had left-sided frontal headache that resolved on its own. on and 24 he felt fine. then on am while at work (oil machine technician) the headache recurred, was ~ in intensity, same location though did also extend down left side of neck as well. shortly thereafter he had minute episode of lightheadedness and feeling unsteady on his feet, as if he was going to pass out. denied any otehr symptoms, including chest pain, palpitations, vertigo. the lightheadedness and unsteadiness recurred and did not resolve. he then called his wife who drove him to . while in ed he developed nausea and vomiting. he reports that since last night his symptoms have progressed, and now include diploplia in all directions of gaze, far objects worse than near, tingling of distal left arm, decreased strength of left arm and leg, clumsiness of left arm and inability to sit up due to weakness and also worsening of his dizziness. per records from , initially with dizziness/unsteadiness and headache with left-sided neck pain, complaining of numbness in left hand and face but strength intact. dizziness increased with head motion, and pt reported difficulty sitting up because it incresed his nausea and felt like he would pass out. in ed, had sinus bradycardia, which he did have in past, but since he was dizzy and lightheaded with left arm numbness he was admitted to icu and ruled out for mi. head ct showed left maxillary sinusitis and no intracranial pathology. he was seen by neurology consult ~7pm , and had pendular and all-direction nystagmus, mild left face numbness, full strength except left hand intrinsics and wrist extensors, mild decreased sensation left arm and leg. overnight he developed progressive left-sided weakness and clumsiness, and difficulty sitting up and is transferred to us for further management. also of note, initially afebrile, on transfer was 99.8 rectally, and wbc increased 10.8 to 14. ros: reports he had cold several weeks ago, with some coughing. also had left lower abdominal pain and diarrhea for 1 day last week, and then again on . has left knee arthritis. no difficulty speaking per pt. does report perhaps some choking on water from mouth swabs today. past medical history: 1. s/p right hernia repair 2. h/o kidney stones ~20 years ago no htn, high cholesterol, diabetes social history: works as oil machine tech which is where he was during symptom onset. also volunteer firefighter, emt. lives with wife, has 2 grown stepsons. quit tobacco 25-30 years ago. has 1 drink ~4x/week. no other drugs except rare marijuana as teen. family history: father with 's age 47, died of stroke. brother with dm since age 23, sister with borderline type ii dm. physical exam: t 98.3 bp 132/55 hr 40s o2 sat 97% on 2l nc general: appears stated age, in no acute distress, lying nearly flat in bed heent: nc/at sclera anicteric. op clear neck: supple. lungs: clear to auscultation bilaterally cv: brady, reg rhythm, nl s1, s2, no murmur. 2+ carotids without bruit. soft bruit over vertebrals bilaterally abd: soft, nontender, normoactive bowel sounds extr: no edema, teds hose on neurologic examination: mental status: alert and oriented to person, place and date, cooperative with exam, normal affect attention: can say months of year backward language: fluent, no dysarthria, no paraphasic errors, naming, repetition and intact registration: items, recall items at 3 and 15 minutes no apraxia, no neglect cranial nerves: visual fields are full to finger counting. pupils round but unequal, reactive to light, 5 to 3mm on right and 4 to 2 mm on left, brisk. at midline position, left eye slightly down and out, has pendular and multi-directional nystagmus. also with nystagmus in all other directions of gaze. decreased right eye abduction. reports +diploplia, mostly diagonal, in all directions of gaze, worse on rightward than leftward gaze. facial sensation and facial movement normal bilaterally. hearing decreased to finger rub in left ear (old). tongue midline, no fasciculations. sternocleidomastoid and trapezius normal bilaterally. motor: normal bulk and tone bilaterally, fasiculations absent in upper and lower extremities. no tremor. +pronator drift on left. overall has left upper motor neuron hemiparesis arm>leg, and right ip in context of pain in left groin with leg lift. strength: d t b we fif ip q h df pf te right 5 5 5 5 5 5 4 5 5 5 5 5 left 4 4 4+ 4+ 5 4+ 4- 5 4 5- 5 4+ sensation was intact to light touch and proprioception. reflexes: dtrs decreased at knee, ankles and also decreased in left arm compared with right. coordination: severely ataxic on left, with truncal ataxia and falls to left when sitting as well. gait deferred given ataxia, dizziness, need to keep hob flat to maximize cerebral perfusion. pertinent results: 11:19pm ptt-31.6 12:55pm glucose-87 urea n-18 creat-0.8 sodium-139 potassium-4.1 chloride-104 total co2-23 anion gap-16 12:55pm alt(sgpt)-25 ast(sgot)-22 ck(cpk)-88 alk phos-103 tot bili-1.8* 12:55pm ck-mb-notdone ctropnt-<0.01 12:55pm calcium-8.9 phosphate-3.2 magnesium-1.9 cholest-151 12:55pm %hba1c-6.3* -done -done 12:55pm triglycer-71 hdl chol-53 chol/hdl-2.8 ldl(calc)-84 12:55pm wbc-12.6* rbc-4.46* hgb-14.2 hct-39.0* mcv-88 mch-31.8 mchc-36.4* rdw-12.7 12:55pm neuts-85.2* lymphs-10.7* monos-3.6 eos-0.3 basos-0.1 12:55pm plt count-267 12:55pm pt-12.8 ptt-25.7 inr(pt)-1.1 mri/mra: : acute infarct in the medulla. patent left vertebral artery, although a probable filling defect is seen within the artery at the same level. angio: selective diagnostic left subclavian and left vertebral arteriography was performed, revealing mild ostial left vertebral artery stenosis along with a partial dissection of the distal left vertebral artery. in addition, there is abrupt termination of the left posterior inferior cerebellar artery, consistent with infarct. repeat head ct: no acute intracranial hemorrhage or mass effect. vasculature not well assessed by ct without contrast. brief hospital course: 59m with no pmh presented to with ha, and lightheadedness and unsteadiness on feet (denied vertigo). admitted for ?lyme and started on ceftriaxone. however, overnight he progressed to diploplia, central vertigo, left ataxic hemiparesis and left truncal ataxia, with crossed sensory loss (pin/cold on right and light touch on left) and tx'd to us. had head ct neg x2. hospital course: neurology pt had mri and mra that showed left lateral medullary infarct and suggestion of l vertebral dissection. on cerebral angiography performed that showed vertebral dissection just before pica. based on this finding, he was started on therapeutic iv heparin and coumadin, wtih plans to continue the heparin until his inr was . he also was started on a baby aspirin. underwent a stroke workup that included lipid panel, hemoglobin a1c. the lipid panel was relatively normal, but ldl was slightly elevated at 84. he was started on lipitor 10 mg qday. however, on he developed vomiting with coffee ground emesis. because there does not exist clear evidence supporting anticoagulation for vertebral dissection, it was decided that the heparin and coumadin would be stopped and the patient would be continued only on aspirin. cv: patient ruled out for mi based on ekg and cardiac enzymes. has sinus bradycardia at baseline. cardiology was consulted regarding this bradycardia and they were unconcerned about asymptomatic sinus brady, recommended no further workup. id: on admission he had an elevated wbc, borderline temps, maxillary sinusitis on ct. he was started on afrin for sinusitis/left-sided headache x3 days. fever curve remained stable and his wbc count decreased and therefore no antibiotics were started. fen: he was initially npo given medullary infarc. upon transfer to the floor he underwent an initial speech and swallow evaluation that showed that he was safe for nectar thick liquids. prior to discharge a repeat swallow eval passed him for solids, with chin tuck. he tolerated this diet well with no evidence of aspiration. gi: he had some nausea during his hospitalization treated well with zofran. with regards to the coffee ground emesis, he was being treated with protonix during his hospitalization, and he was scheduled for an outpatient egd. he was continued on low dose lipitor. dispo: he was discharged to an acute rehab facility on in stable condition. update : patient doing well; placed on pureed diet with supervised feedings; following ptts, started on warfarin; d/c'd foley : headache, but ct showed no hemorrhage. update : now has 2 ptts in range, no need to follow q6; cont. on warfarin. will likely go to rehab in next day or two medications on admission: (home): glucosamine, tylenol prn, asa 325 "when i remember" (current): ceftriaxone 1gm, asa 81, ibuprofen 600 tid, protonix 40, meclizine 12.5 discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. atorvastatin calcium 10 mg tablet sig: one (1) tablet po daily (daily). 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). discharge disposition: extended care facility: - discharge diagnosis: left lateral medually infarct secondary to left vertebral dissection discharge condition: improved discharge instructions: you will have upper endoscopy on . please report to the , building at 1:15 pm. do not eat after midnight on the day of the procedure. followup instructions: provider: , md where: building (/ complex) endoscopy suite phone: date/time: 2:15 provider: suite gi rooms where: gi rooms date/time: 2:15 provider: , .d. where: neurology phone: date/time: 2:30 md, procedure: arteriography of cerebral arteries diagnoses: other specified cardiac dysrhythmias cerebral artery occlusion, unspecified with cerebral infarction unspecified sinusitis (chronic) dissection of vertebral artery 

Answer: The patient is high likely exposed to