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 / shellfish attending: chief complaint: r eyelid drooping, slurred speech, code stroke major surgical or invasive procedure: intraarterial tpa thrombolysis right vertebral artery stent placement history of present illness: pt. is a 57 year old with a history of asthma, htn, hyperlipidemia, tobacco abuse, who presents with eyelid drooping and slurred speech. code stroke called at 3:33, neurology at the bedside by 3:38. pt. reports that she was at work this afternoon at 1:55 when she suddenly noticed that her right eyelid was drooping, and she had trouble keeping her eye open. over the next 5-10 minutes her symptoms progressed, and she also noticed that her left eye was drooping and that the left side of her face was numb, like she'd just gotten a novacaine shot there. she noticed that her speech was slurred. she felt very dizzy, like the room was spinning. she had double vision, which she thinks was vertical. she told her co-workers and they called ems, and she was transported here. since she arrived here she feels that her speech has gotten more slurred, and that she has developed trouble swallowing, and feels like she is gagging on her secretions. she is not able to open either eye enough to see. she still feels dizzy. on ros she denies any recent fever, chills, or uri symptoms. she has had some dysuria in the past few days. she does not remember any trauma to her head and neck. she just got home from a vacation on saturday, and was lugging her baggage around the airport, and had a 3 hour flight. she denies any weakness or numbness in her arms or legs. past medical history: kidney stone with pyelonephritis in osteopenia gerd asthma hyperlipidemia hypertension migraines- last one over a year ago seen by neurology here in for an episode of sudden onset shooting pain l eye, followed by burning with looking up and to the left, diagnosed with trochleitis b12 deficiency social history: + tobacco 1 ppd, glasses of wine/week, financial consultant at ag , no children family history: mother -> died of lung ca at 65 father -> died of pe at 55 brother -> htn physical exam: t- 95 bp- 153/73 hr- 93 rr- 20 o2sat- 96% on ra gen: lying in bed, nad, eyes closed heent: nc/at, moist oral mucosa neck: no tenderness to palpation, normal rom, supple cv: rrr, nl s1 and s2, no murmurs/gallops/rubs lung: clear to auscultation bilaterally abd: +bs soft, nontender ext: no edema nih ss: 5 1a. level of consciousness: 0 1b. loc questions: 0 1c. loc commands: 0 2. best gaze: 1 3. visual: 0 4. facial palsy: 1 5a. motor arm, left: 1 5b. motor arm, right: 0 6a. motor leg, left: 0 6b. motor leg, right: 0 7. limb ataxia: 1 8. sensory: 0 9. best language: 0 10. dysarthria: 1 11. extinction and inattention: 0 neurologic examination: mental status: awake and alert, cooperative with exam, normal affect. oriented to person, place, and date. attentive. speech is fluent with normal comprehension and repetition; naming intact. mild dysarthria, scanning speech with , easily understanding. intact. no right left confusion. cranial nerves: pupils pinpoint and reactive bilaterally. visual fields are full to confrontation. r eye abduction incomplete (just barely past midline). unable to adduct r eye at all. able to abduct l eye fully, adduction incomplete. impaired upgaze on r > l. sensation decreased to light touch v2- v3 on l. bilateral ptosis, r > l (cannot open r eye at all, just opens l eye 5 mm). mild nlf flattening on l. hearing intact to finger rub bilaterally. palate elevation symmetrical. sternocleidomastoid and trapezius normal bilaterally. tongue midline, movements intact motor: normal bulk bilaterally. tone normal. no observed myoclonus or tremor. + pronator drift on left tri wf we fe ff ip h q df pf te tf r 5 5 5 5 5 5 5 5 5 5 5 5 5 5 l 4+ 4+ 5- 5 5- 4+ 5 5 5 5 5 5 5 5 sensation: intact to light touch, vibration and proprioception throughout. no extinction to dss reflexes: +2 and symmetric throughout. toes upgoing bilaterally coordination: dysmetria with finger-nose-finger and heel to shin on left gait: not assessed pertinent results: admission labs: 141 104 19 -------------< 139 3.7 24 0.9 wbc 9.4 hgb 14.9 plt 394 hct 42.2 mcv 87 n:59.4 l:33.5 m:4.9 e:1.7 bas:0.6 pt: 11.0 ptt: 22.3 inr: 0.9 imaging cta head and neck with perfusion: on the unenhanced scan, there is no evidence for acute ischemia or hemorrhage. on the ctp, there is no evidence for global perfusion defect in the mca territory. preliminary evaluation of the cta images demonstrate what appears to be occlusion of the distal basilar artery extending to the proximal right pca artery. this area also appears to be hyperdense on unenhanced ct. no definite acute infarction in the brainstem or cerebellum is seen, although mri evaluation would be recommended for further evaluation. there is a 4.5-mm right lung apical nodule for which recommend correlation with dedicated chest ct. the right distal vertebral artery appears to taper to a thread and there is also a filling defect in the v4 segment, suggesting of acute nonocclusive thrombus. in light of this finding, the filling defect in the distal basilar artery could represent an acute clot from the right distal vertebral artery dissection rather than basilar artery thrombosis in the setting of atherosclerotic basilar artery disease. impression: preliminary images highly concerning for distal basilar artery thrombosis. no definite acute infarction is seen in the cerebellum or brainstem, but would recommend correlation with mri. repeat head ct at 5:47: head ct without contrast: there is no acute intracranial hemorrhage, mass effect, shift of normally midline structures or hydrocephalus. there is a hyperdense appearance of the distal basilar artery which correspond to the area of thrombosis seen on prior cta. the surrounding osseous and soft tissue structures are unremarkable. impression: no acute intracranial hemorrhage. hyperdense appearance to the distal basilar artery consistent with recently diagnosed thrombosis. tte conclusions: the left atrium is normal in size. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. the estimated right atrial pressure is 5-10 mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%) transmitral doppler and tissue velocity imaging are consistent with normal lv diastolic function. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. compared with the prior study (images reviewed) of , no change. no source of embolism identified. mr head w & w/o contrast 8:23 pm mri brain: areas of slow diffusion are seen in the pons right greater than left, left superior cerebellum, and right cerebellum. also seen are infarcts in the left occipital lobe. these correspond to areas of low diffusion coefficient on adc map, and probably represent acute infarction secondary to the previous basilar thrombus. these findings are corroborated on the flair and t2 images. no other areas of cerebral infarction are seen. ventricles and sulci retain their normal caliber and configuration. there is fluid in the sphenoid sinuses. mr angiography head: the basilar artery and posterior circulation appear now patent. the internal carotid arteries, circle of and major branches also appear patent. posterior cerebral arteries appear to be fed by the posterior circulation; no definite posterior communicating arteries are seen. mr angiography neck: the right vertebral artery has loss of signal at its origin, which may be due to the recently placed stent. however, due to artifact from the stent, we cannot assess the possibility of a stenosis. otherwise, the right vertebral artery, left vertebral artery, right and left common and internal carotid arteries are patent. impression: reconstitution of flow in the basilar artery and branches, with bilateral posterior circulation infarctions, including the right cerebellum, left cerebellum, and pons. cta head w&w/o c & recons 2:35 pm head ct: there is a large infarct involving the right cerebellar hemisphere and a small infarct involving the superior portion of the left cerebellar hemisphere as well as small infarcts involving the pons and midbrain. there are no intracranial hemorrhages. the ventricles and extra-axial csf spaces are unchanged. air-fluid levels are seen within the sphenoid air cells bilaterally. no suspicious bony abnormalities are noted. cta head and neck: a stent is seen at the origin of the right vertebral artery. the intraluminal content is difficult to visualize due to the streak artifacts from the stent but there appears to be contrast within the lumen. the vertebral artery distal to the stent is widely patent. the right vertebral artery is dominant. incidental note is made of a prominent right posterior meningeal artery arising from the v3 segment of the right vertebral artery. the basilar artery is patent. there is minimal atherosclerotic disease involving the origin of the left vertebral artery, which comes off directly from the aortic arch. minimal atherosclerotic disease at the origin of the left subclavian artery is also noted. minimal calcified atherosclerotic plaques are seen involving the bulbs of the internal carotid arteries bilaterally. the maximal diameter of the left internal carotid artery at its bulb is 7 mm. the distal cervical left internal carotid artery has a diameter of 4.6 mm. the right internal carotid artery bulb has a diameter of 5.6 mm and the distal cervical right internal carotid artery has a diameter of 5.8 mm. again seen is a 3 x 3 mm outpouching of the right supraclinoid internal carotid artery which likely represents a posterior communicating artery infundibulum. no new occlusions or stenoses are seen. there are several small nodular densities of the visualized lung apices bilaterally some of which are peripheral. a dedicated chest ct as previously recommended is again recommended. degenerative changes of the cervical spine are again seen with multilevel foraminal stenosis. impression: 1. stent at the origin of the right vertebral artery which makes the evaluation of the intraluminal contents difficult due to streak artifacts but there is some contrast within the lumen and the vertebral artery distal to the stent is widely patent. 2. the basilar artery and its major branches are completely patent. 3. a chest ct to further evaluate multiple small nodular densities is again recommended. brief hospital course: ms. is a 57 year old with a history of asthma, htn, hyperlipidemia, tobacco use, who presented with acute onset of bilateral ptosis, diplopia, dsyarthria, dysphagia, and vertigo. on initial exam she had evidence of a 3rd and 6th nerve palsy on the r, and 3rd nerve palsy on the left, bilateral ptosis, dysarthric speech, left nasolabial flattening, and l umn pattern weakness in the arm. these signs and symptoms were consistent with brainstem localization for possible infarction. on cta she had evidence of a large basilar artery thrombus. since she was in the window for ivtpa and had no contraindications to tpa, this was administered at 16:40 on . one hour later her course in the ed was complicated by acute decompensation, with decreased level of arousal and vomiting. she was acutely intubated and sedated, and head ct was repeated, which showed no evidence of hemorrhage. the most likely cause of this deterioration was propagation of the thrombus. she was rushed to the interventional radiology suite where she underwent intra-arterial tpa thrombolysis. angiogram showed a severe narrowing of the proximal vertebral artery on the left (atherosclerosis versus dissection). the mid to distal portion of the basilar artery was closed and there was thrombus that extended into both pcas. a total dose of 11mg of tpa was infused in the basilar artery and both pcas. limited revascularization was achieved, but the basilar artery successfully opened up. there was still some clot in the proximal right pca and sca. a stent was placed in the right proximal vertebral artery with return of good flow to the basilar artery, and proximal portions of the scas and the proximal pcas she has a history of several recent plane flights as well as multiple vascular risk factors. she has a history of pulmonary embolism in the distant past. she was admitted to the neuro icu following her several procedures and monitored. she was successfully extubated without complication and trasferred to the neurology floor. she was the cause of her infarct is unknown at present, given her vascular risk factors (long time smoker, htn, hyperlipidemia) could consider atherosclerotic plaque in the basilar with thrombosis. could also consider a cardioembolic source (though no known a fib) echocardiogram did not reveal pfo, asd, or sources for cardioemboli. she was started on aspirin 81mg daily 24 hours following tpa administration. her discharge examination was notable for right eye ptosis and slight bilateral deficit of eye abduction. a hypercoagulable work up will proceed with dr. in follow up clinic at vascular neurology center at . she was discharged to home with physical therapy services. chest ct is recommended at follow up for evaluation of multiple small nodular densities seen incidentally on cta of the neck. medications on admission: diovan 120 mg qd hctz 12.5 mg qd advair 250/50 twice daily albuterol prn lipitor 10 mg qd discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*60 tablet(s)* refills:*3* 2. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. hydrochlorothiazide 12.5 mg capsule sig: one (1) capsule po once a day. capsule(s) 5. diovan oral 6. albuterol 90 mcg/actuation aerosol sig: two (2) puff inhalation q4h (every 4 hours) as needed. 7. lipitor 10 mg tablet sig: one (1) tablet po once a day. discharge disposition: home with service facility: homecare discharge diagnosis: basilar artery thrombosis discharge condition: right ptosis. slight right lateral eye abduction deficit. discharge instructions: you were admitted for a stroke. you underwent extensive intervention to break up the clot and prevent further neurologic deficits. quit smoking. please continue to take all medication as prescribed. call your doctor or 911 if you experience any difficulty with speech, walking, new weakness, numbness, tingling, weakness, double vision, blurred vision or any other concerning symptoms. followup instructions: at 1:30pm with dr. . he will order some blood work to be drawn for potential clotting disorder. please call prior to your appointment to update your insurance information. you will also have home physical therapy services. md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube injection or infusion of thrombolytic agent complete thyroidectomy percutaneous insertion of other extracranial artery stent(s) percutaneous angioplasty of extracranial vessel(s) cranial or peripheral nerve graft insertion of one vascular stent procedure on single vessel diagnoses: esophageal reflux tobacco use disorder unspecified essential hypertension asthma, unspecified type, unspecified other and unspecified hyperlipidemia occlusion and stenosis of basilar artery with cerebral infarction ptosis of eyelid, unspecified 

Answer: The patient is high likely exposed to