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: confusion with blurry vision major surgical or invasive procedure: s/p intravenous tpa transesophageal echocardiogram history of present illness: the pt is a 80 y/o rhm who presents with visual field loss. was at a graduation party when he suddenly noticed a field cut in his right upper quadrant. daughter in law who is an internist recognized this and gave him asa 325mg x1. he was brought in within an hour. here his only complaints was the right upper quadrant field loss. the son though his memory was off as he repeated questions over and over and was not remembering his medications by name. he noted no other specific weakness, numbness, slurred speech or facial droop. on ros: no cp, sob, fever, chills, n/v, constipation, has arthritic pain in hands and legs. he has no recent history of strokes, has no recent hospital admits or visits. no recent surgeries, stated his gi bleed was many years ago. time stroke called 9:15 pm time at bedside 9:15 pm time last known well 8:15 pm nih ss 1 tpa yes time/reason 10:30pm for perfusion diffusion mismatch. i was present during the ct scanning and reviewed the images instantly within 20 minutes of their completion. past medical history: 1. htn 2. gout 3. gi bleed from nsaids 4. bph 5. tia 15 years ago (hearing issues) 6. psoriasis 7. hyperlipidemia 8. s/p r ankle repair and r total knee replacement in 9. l carotid occlusion 10. cad social history: lives with wife, 3 grown children. + tobacco- 1ppd x 20y, quit several years ago. denies etoh and illicit drugs. family history: father died of mi at age 57. mother died of cva at age 80. physical exam: physical exam on admission: vitals: t:98 p:65 r: 16 bp: 171/68 sao2:99% general: awake, cooperative, nad. heent: nc/at, no scleral icterus noted, dry mm neck: obese neck. pulmonary: lungs cta bilaterally cardiac: rrr, nl. s1s2, no m/r/g noted abdomen: soft, obese. extremities: 2+ edema le's to mid shin. skin: psoriatic rash noted in chest/ arms. neurologic: mental status: alert, oriented x 3. able to relate history without difficulty. not attentive, had difficulty repeating three words and with dow backward. language is fluent. on naming he said hand (for glove, little finger for pinky, and fist for knuckles, he was able to name these correctly after some time.. able to read without difficulty. speech was not dysarthric. able to follow both midline and appendicular commands. register and recall . the pt. had good knowledge of current events. cranial nerves: i: olfaction not tested. ii: perrl 3 to 2mm and brisk. right upper quadrant cut with some extension to lower right quadrant. iii, iv, vi: eomi without nystagmus. normal saccades. v: facial sensation intact to light touch. vii: no facial droop, facial musculature symmetric. viii: hearing decreased b/l. ix, x: palate elevates symmetrically. : 5/5 strength in trapezii bilaterally. xii: tongue protrudes in midline. motor: normal bulk, tone throughout. no pronator drift bilaterally. no tremor, asterixis noted. delt bic tri wre ffl fe io ip quad ham ta l 4 5 5 5 5 5 - 5 5 5 5 5 5 r 4 5 5 5 5 5 - 5 5 5 5 5 5 sensory: no deficits to light touch, . no extinction to dss. dtrs: tri pat ach l 2 2 2 0 0 r 2 2 2 0 0 plantar response was flexor bilaterally. coordination: no intention tremor, no dysdiadochokinesia noted. gait: deferred pertinent results: 09:30pm blood wbc-13.2* rbc-4.50* hgb-14.4 hct-41.3 mcv-92 mch-31.9 mchc-34.8 rdw-14.7 plt ct-318 06:10am blood wbc-14.5* rbc-3.94* hgb-12.5* hct-36.6* mcv-93 mch-31.9 mchc-34.3 rdw-14.2 plt ct-333 09:30pm blood pt-13.3 ptt-25.7 inr(pt)-1.1 09:30pm blood glucose-115* urean-27* creat-1.2 na-142 k-3.8 cl-104 hco3-26 angap-16 09:30pm blood ctropnt-<0.01 03:57am blood ctropnt-<0.01 03:57am blood calcium-8.7 phos-3.7 mg-2.1 cholest-151 08:32am blood %hba1c-5.4 eag-108 03:57am blood triglyc-66 hdl-35 chol/hd-4.3 ldlcalc-103 cta/p of head and neck: 1. occlusion of the left pca at the p2 level with increased mean transit time and within this area a territory of decreased cerebral blood flow and volume. this has been suggested to represent irreversible injury, although the reliability of this finding has not been resolved. 2. occlusion of the right internal carotid artery at its origin with collateral perfusion of the right anterior circulation. mri of the brain on : impression: 1. hemorrhagic transformation of the left posterior cerebral artery infarct with mild local mass effect. 2. no evidence of a new acute cortical infarction. tte on : no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. right atrial appendage ejection velocity is good (>20 cm/s). no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there are complex (>4mm) non-mobile atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is no pericardial effusion. brief hospital course: patient is a 80 year old rhm with cad, htn, hld, gout and known l ica occlusion here after acute confusion and blurry vision. he was given asa 325mg per family member who was a physician and arrived at the hospital as code stroke. although his nihss score was only 2 for confusion and field cut, his vision was worsening and he arrived soon after onset of witnessed trouble hence he was given iv tpa then admitted to the icu. follow-up imaging including mri showed l pca infarct with p2 cut-off. his vessel imaging was unremarkable otherwise and given the concern for more proximal source of thrombus, he underwent tte (transthoracic echo) followed by tee (transesophageal echo) which showed no source of embolus. he did have immobile thrombus in the descending arch but given the location, this will not explain his stroke. patient was transferred to the floor where he remained stable except for gouty flare. 1. l pca infarct - patient's main deficit is short-term memory from mesial-temporal lobe involvement. patient is started on asa 325mg and continues on pravastatin 60mg daily for cholesterole control. his ldl was 103 during this admission. his glucose control was checked during this admission and his hba1c was 5.4% reflecting no evidence of diabetes. again, he underwent tte followed by tee which were normal and no evidence of the cardioembolic source hence he did not warrant anticoagulation. he was also monitored on telemetry during this admission with normal sinus rhythm. patient's atenolol was 'd during this admission but can take the home dose (25mg) upon discharge to . prognosis for the patient is excellent. he will likely have much improvement of his cognitive deficits and memory trouble over the next 3~6 months. 2. gouty flare - patient had gouty flare involving his left elbow, left knee and great toe. colchicine was tried with little efficacy hence rheumatology was consulted at the suggestion of dr. (outpatient pcp) and patient was given iv solumedrol followed by prednisone taper. he received 1 dose of iv solumedrol 40mg on followed by prednisone taper. he received 30mg on - the day of his discharge and he should receive 25mg of prednisone on -> 20mg on -> 15mg on -> 10mg on -> 5mg on then completely discontinued. given his propensity for gout and gouty flares are common after strokes, patient may need steroids should his gout flare up again. also, patient needs to be maintained on allopurinol for prevention. 3. cellulitis - patient has cellulitis involving r antecubital fossa. although he did not have a fever and his leukocytosis may be a reflection of his gouty flare, he was given clindamycin for cellulitis. this was started on and to be continued for 5 days total. 4. follow-up - patient is recommended to follow-up with dr. 1~2 weeks after discharge from . he also has an appt to follow-up with dr. who oversaw his care during this admission. medications on admission: atenolol 25mg allopurinol 100mg pravastatin 40mg triamcinalone crm discharge medications: 1. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 2. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 3. atenolol 25 mg tablet sig: one (1) tablet po daily (daily). 4. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 5. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 6. pravastatin 20 mg tablet sig: three (3) tablet po daily (daily). 7. heparin (porcine) 5,000 unit/ml solution sig: one (1) syringe injection tid (3 times a day): can stop once ambulating regularly. 8. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day): hold for loose stools. 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day): hold for loose stools. 10. clindamycin hcl 150 mg capsule sig: two (2) capsule po q8h (every 8 hours) for 4 days: cellulitis involving r arm. 11. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical (2 times a day) as needed for dry skin. 12. prednisone 5 mg tablet sig: five (5) tablet po daily (daily) for 5 days: 25 mg x 1 on , then 20 mg x 1 on , then 15 mg x 1 on , then 10 mg x 1 on , then 5 mg x 1 on then off order was filled by pharmacy with a dosage form of tablet and a strength of 5 mg . discharge disposition: extended care facility: - discharge diagnosis: l pca infarct gouty flare discharge condition: mental status: confused - always. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). neuro deficits: confused - unable to recall short term memory. oriented to self but unclear about recent events and place at times. right superior quadranopia. some weakness of l side especially the leg but pain-limited weakness due to gouty flare currently involving l elbow, l knee and l great toe. discharge instructions: you were admitted to the hospital after presenting with acute confusion and possible vision problem. although your deficits appeared minimal, your vision was getting worse and given the documented, acute onset, you were given iv tpa then admitted to the icu under neurology service. further imaging showed left pca infarct involving mesial temporal lobe causing confusion and severely poor short term memory. you also have a right superior quadranopia given the loop involvement. there was hemorrhagic transformation after tpa but follow-up imaging of ct scan showed stable hemorrahge with no mass effect. although the vessel imaging showed a left p2 cut-off, transthoracic and tranesophageal echocardiogram was done performed to assess for possible proximal source of embolus. both echocardiograms showed no evidence of cardiac source. you also had a severe gouty flate involving left elbow and knee. after discussing with your pcp, . , rheumatology was consulted and you were given iv solumedrol followed by prednisone taper (30mg daily and taper down by 5mg/day). given you cognitive and visual deficits with some gait trouble, you are discharged to for inpatient therapy. followup instructions: please follow-up with dr. within 1~2 weeks of discharge from the rehabilitation facility. provider: , md phone: date/time: 11:00 please follow-up with the neurologist who oversaw your care during this admission: provider: , md, phd: date/time: 1:00 building ( ), . procedure: diagnostic ultrasound of heart injection or infusion of thrombolytic agent diagnoses: intracerebral hemorrhage other and unspecified hyperlipidemia cellulitis and abscess of upper arm and forearm personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits cerebral embolism with cerebral infarction acute gouty arthropathy homonymous bilateral field defects 

Answer: The patient is high likely exposed to