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: code stroke - s/p fall major surgical or invasive procedure: intubation history of present illness: the patient is an 83 yo woman with hx htn and "leaky valve" according to the patient's daughter who provided history over the phone. she had been in usoh with no recent illnesses, and had apparently driven to kmart with her husband late morning day of admission and husband waited in the car; at 12:01 she was found down in the aisle, not talking coherently. ems was called and arrived at 12:06; at the scene they found her (described as "collapsed," not reacting to verbal stim, with a left facial droop. bg was 157. she arrived at er at 12:35 pm, code stroke activated at 12:38 pm. stroke team arrived at bedside within one minute. on our initial assessment her nih stroke scale scored 26 for: left sided weakness, not anti-gravity but some movement, inattention to left side, moderate to severe dysarthria, mild to moderate aphasia with inability to provide loc. she was taken to the ct scanner which demonstrated a large clot in her proximal right mca. her inr was found to be 1.2. at 13:15 the patient recieved a bolus of tpa (9 mg) and had an infusion of 81 mg over an hour. subsequent mri/a of the brain showed large area of infarct with no recannulization of mca. she was transferred to the icu for further care and monitoring s/p tpa. ct of the neck was performed for trauma. ct of the neck wet read as follows: "no definable fracture. prominent multilevel cervical spondylosis causing multilevel foraminal stenosis, moderate-prominent, and prominent cord compression, most evident in the caudal cervical region. prominent bilateral common carotid bifurcation atherosclerotic calcification." ros: no recent illnesses per family report; pt has hx swelling of lower lip with no clear allergic trigger; pt currently has a rash (prior to hospitalization). past medical history: htn valvular disease (unclear details, but patient had apparently been advised to start coumadin by doctor but she did not want to considering risks. no artificial valve or history of valve surgery). ??hx afib?? history of miscarriages "several" per daughter surgeries in past social history: the patient's daughter has had dvts and pes, most recently in (s/p thrombectomy). she has been told that she has a genetic disorder "on chromosome 16" but does not remember further details. breast cancer runs in the family (several relatives), but there are no early strokes or mis. family history: the patient's daughter has had dvts and pes, most recently in (s/p thrombectomy). she has been told that she has a genetic disorder "on chromosome 16" but does not remember further details. breast cancer runs in the family (several relatives), but there are no early strokes or mis. physical exam: exam following tpa and limited by ativan for mri (see hpi for initial exam pre-tpa) examination: t 99.4 bp 175/100 hr 90s rr 18 general appearance: older white female appears nervous but no distress prior to mri; the rest of her exam was limited by ativan that she received at mri scanner heent: swollen, protruding lower lip with ?bite mark; no blood on tongue; chipped left upper incisor - "old" per family neck: no bruits, hard collar in place heart: sounds regular rate, no audible murmurs lungs: clear to auscultation bilaterally. abdomen: soft, nontender +bs extremities: warm, well-perfused mental status: the patient was initially awake and anxious, could say her name with mod dysarthria, and could name; not able to assess further. following tpa she got mri requiring 1mg ativan; she moved her right hand and leg in response to voice but was difficult to arouse - more vigorous right sided movement with sternal rub. cranial nerves: perrlb, eye deviation to right, +ocr, left facial droop, + corneals, unable to assess sensation otherwise; pt protruded tongue earlier on command and it looked midline but could not see palate secondary to neck in hard collar. hearing diminished bilaterally when more awake. sensory-motor system: the tone on the left side when pt less responsive was increased and she did not follow commands at this time. when hand placed in hers, she could provide good resistance and push up with delt, extend with triceps and pull with biceps, and squeeze hand. could not test wrist and finger extensors. there was no mvmt to nailbed on the left ue. lle with triple flexion, and rle with excellent spontaneous mvmt. could not assess further sensory at this time. reflexes: the tendon reflexes are present and trace in the upper and lower extremities bilaterally with absent achilles reflexes. the left toe goes up, the right down. coordination: could not assess due to the patient's somnolence. gait: gait could not be assessed, pt recently s/p tpa pertinent results: 12:55pm pt-14.0* ptt-25.3 inr(pt)-1.2* 12:55pm plt count-193 12:55pm neuts-63.2 lymphs-30.0 monos-4.1 eos-2.4 basos-0.4 12:55pm wbc-10.4 rbc-4.89 hgb-14.6 hct-42.8 mcv-88 mch-29.9 mchc-34.1 rdw-15.0 12:55pm tsh-6.1* 12:55pm tsh-6.1* 12:55pm albumin-4.6 calcium-9.9 phosphate-3.5 magnesium-1.9 cholest-190 12:55pm ck-mb-notdone 12:55pm ctropnt-<0.01 12:55pm lipase-30 12:55pm alt(sgpt)-14 ast(sgot)-30 ld(ldh)-285* ck(cpk)-93 alk phos-67 amylase-52 tot bili-0.5 12:55pm glucose-145* urea n-16 creat-0.9 sodium-141 potassium-3.6 chloride-102 total co2-26 anion gap-17 01:50pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 01:50pm urine color-straw appear-clear sp -1.010 01:50pm urine gr hold-hold 01:50pm urine hours-random 03:32pm %hba1c-7.1* -done -done ct brain non-contrast head ct scan: there is no evidence of acute intracranial hemorrhage or shift of the normally midline structures. the ventricles and cisterns are normal. there is hyperdensity within the right middle cerebral artery, worrisome for thrombosis at this locale. the density values of the brain parenchyma appear normal at this time, with preservation of the - white matter differentiation. visualized paranasal sinuses and mastoid air cells are clear. osseous and soft tissue structures are unremarkable. impression: no evidence of acute intracranial hemorrhage. hyperdense right middle cerebral artery, suggesting acute thrombosis. mri following tpa mri of the brain: there is restricted diffusion throughout the right middle cerebral artery territory, including the right insular cortex, basal ganglia and portions of the right posterior parietal and right temporal lobes, consistent with acute infarction. there is minimally increased signal in this distribution on the t2 and flair sequences. there are several foci of increased t2 and flair signal within the cerebral periventricular white matter bilaterally, consistent with chronic microvascular infarction. there is a small focus of elevated t2 and flair signal within the left cerebellum, consistent with a small old infarct. there is no hydrocephalus. there are no areas of abnormal susceptibility with the brain. mra of the circle of : technique: 3d time-of-flight images of the circle of were obtained, with 3d reformatted images. mr angiogram of the circle of : consistent with acute right middle cerebral artery territory infarction, no flow is visualized beyond the proximal most m1 segment of the right middle cerebral artery. also of note, there is diminished or absent signal within the right vertebral artery, suggesting slow flow versus occlusion on these 3d time-of-flight images. no other areas of stenosis and no areas of aneurysmal dilation are noted within the major tributaries of the circle of . impression: 1. acute right middle cerebral artery infarction, including infarction of the right insular cortex, right basal ganglia, right posterior parietal and right temporal lobes. 2. no flow is visualized beyond the proximal most m1 segment of the right middle cerebral artery, consistent with occlusion. 3. diminished or absent flow signal within the right vertebral artery, suggesting slow flow versus occlusion of the right vertebral artery. ct performed same day for change in ms ?ativan vs worsening head ct without intravenous contrast: no intracranial hemorrhage is identified. there is evolution of the acute infarction involving the territory of the right middle cerebral artery with loss of the and white matter differentiation, edema, and loss of sulci within the right temporal lobe. there is no significant shift of midline structures. ventricles are normal in configuration without evidence of hydrocephalus. dense right middle cerebral artery is again noted. visualized paranasal sinuses and mastoid air cells are clear. note is made of under-pneumatization of the right side mastoid air cells. surrounding osseous and soft tissue structures are unchanged. the study is slightly limited by patient motion. impression: no intracranial hemorrhage. evolving acute right middle cerebral artery territorial infarct. ct performed for blown pupil, likely herniation : marked edema has developed throughout the right middle cerebral and anterior cerebral arterial territories, encompassing most of the right frontal and temporal lobes, and part of the right parietal lobe, as well as the right basal ganglia. there is a marked increase in mass effect associated with the development of the edema. the right lateral ventricle is flattened and the midline structures are shifted to the left. the left lateral ventricle is dilated. there is uncal herniation. no acute hemorrhage is evident. the left cerebral parenchyma is of normal attenuation. there is narrowing of the left cerebral sulci due to the mass effect from the right-sided edema. impression: right middle and anterior cerebral arterial distribution infarctions with extensive involvement of the right cerebrum, marked increase in mass effect since the previous day's examination, and uncal herniation. findings were discussed with dr. at 4:17 p.m. on . echo performed conclusions: 1. the left atrium is moderately dilated. the right atrium is moderately dilated. pfo is present. 2. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is probably normal (lvef>55%). 3. the right ventricular cavity is mildly dilated. right ventricular systolic function is normal. 4. the aortic valve leaflets (3) are mildly thickened. 5. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. 6. moderate tricuspid regurgitation is seen. 7. there is a moderate sized pericardial effusion. brief hospital course: 83 yo woman with htn, valvular disease (unclear history, though no hx valve surgeries), miscarriages in the past and family history of hypercoagulable disorder (daughter), who presents after being found down at kmart, last known well time approximated to be 11:45 as she was found in aisle of busy store, s/p tpa for right mca stroke, subsequent imaging with large area of infarct on mri. following mri and ativan, she was very sleepy (for the above exam); it was unclear if this is med effect or related to bleed. she returned to the ct scanner and imaging revealed no acute bleed, just evolution of infarct. of note, physical exam notable for swollen lip, rash - per family, this has happened in past with no identifyable cause; pt had rash prior to receiving tpa. she was transferred to the ticu for further care and physical exam initially appeared unchanged. on at 2:30 pm we were called by nursing (performing q1hr neuro checks) for right pupil dilatation, unreactive. pt evaluated and found to have blown r pupil, other brainstem reflexes intact including ocr, corneals, nasal tickle and gag, still moving right side spontaneously, not moving left leg as much with nox stim. pt intubated after family confirmation of care/full code, and a-line placed. pt received 50g mannitol, hob elevated and brought to ct scanner where imaging showed subfalcine herniation, no bleed (presumed uncal herniation for pupil). family meeting held with dr. , dr. and dr. present and findings/change in status discussed with family. family decided to make her dnr, but to continue ventillation. planned for hyperventillation with goal pco2 30. ct scan performed with worsening herniation. the family decided to change goals of care to cmo; later in the day, she passed away. the cause of death was determined either to be respiratory or cardiac failure from tonsillar herniation, but this could not be differentiated. the family declined autopsy. medications on admission: toprol xl 50mg and asa 81 mg. discharge medications: expired discharge disposition: expired discharge diagnosis: expired cause of death: respiratory and cardiac arrest secondary to tonsillar herniation secondary to stroke. discharge condition: expired discharge instructions: expired followup instructions: expired md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube injection or infusion of thrombolytic agent arterial catheterization diagnoses: unspecified essential hypertension atrial fibrillation cerebral artery occlusion, unspecified with cerebral infarction 

Answer: The patient is high likely exposed to