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: history of present illness: this is a 44 year-old woman with history of multiple sclerosis diagnosed in , maintained on avonex, who was in her usual state of health until one week ago when she went in for an endoscopic retrograde cholangiopancreatography for gallstones. two days after her endoscopic retrograde cholangiopancreatography, she woke up in the middle of the night with an acute headache involving the back of her head. this was very maximal onset and felt like a punch in the back of the head. the head pain was dull and not throbbing. this did not let up at all and two days later she had some nausea and neck stiffness. she did not have any fever, chills, eye pain or bloody vision or other visual symptoms. she states that the headache is worse when she cough or strains. she has had vertigo in the past but this is not the case now. she went to the emergency room yesterday for evaluation and received demerol 25 mg times six as well as versed, phenergan, dilaudid. she had a normal ct scan and a lumbar puncture which showed 0 white cells (tube number four had 10 white cells), 400 red cells (tube four had 240 red cells), glucose 49 and protein 55. no opening pressure was recorded. afterward she felt worse with the headache and it extended to the bifrontal region. she also received one dose of ceftriaxone for meningitis coverage. she currently has a 7 out of 10 headache pain. she does report having occasional headaches around her period located in the occiput. there are no fevers, chills, problems breathing or diarrhea. past medical history: 1) multiple sclerosis treated with avonex with past flares including numbness from the waist down, blurred vision. per patient there were no spinal cord lesions on imaging. 2) avascular necrosis of bilateral shoulders, status post shoulder replacement. 3) tubal ligation. 4) two successful pregnancies, one miscarriage. 5) gallstones. medications at home: effexor 150 mg p.o. q.d., avonex 30 mcg intramuscularly q weekly, flexeril 1 tablet p.o. q..s., percocet p.r.n., protonix 30 mg q.d., ativan 1 mg p.o. b.i.d. p.r.n. allergies: rifampin. social history: she lives at home with her husband. she is a nonsmoker and does not drink alcohol. family history: there is no history of migraines. physical examination: upon admission patient is afebrile, blood pressure 110/80, heart rate 97, 100 percent on room air. this is a well appearing obese female in mild distress. head, eyes, ears, nose and throat: mucous membranes moist, no carotid bruits are noted. lungs are clear to auscultation bilaterally. cardiovascular regular rate and rhythm, no murmur, rubs or gallops heard. abdomen soft, nontender, nondistended. extremities no edema noted. skull and spine neck movements are somewhat limited on lateral rotation, very painful to palpation of the paraspinous soft tissue pressure on the left. on neurologic examination patient is attentive, recalls three out of three objects at three minutes. has good knowledge of her medical history. her language was intact to naming, repetition and comprehension. there is no apraxia or agnosia. on cranial nerve examination visual acuity is 20 out of 25 in od, os and ou. visual fields are full to confrontation. optic disks are extremely difficult to visualize given her discomfort and inability to keep the eyes still. there is no red desaturation. eye movements are normal with deep pupil suggested in the left eye. pupils react normally to light, good direct and consensual. sensation on face is intact to light touch and pinprick. facial movements are normal and symmetric. hearing is intact throughout. there is no nystagmus. the palate elevates in the midline. the tongue protrudes in the midline and is of normal appearance. the sternocleidomastoid and trapezius muscle are strong bilaterally. on motor examination the patient has normal tone and bulk. she had full power 5 out of 5 throughout. there is no pronator drift. on coordination examination there is no ataxia. the finger to nose and heel to shin test are performed accurately. on reflexes are symmetrical and trace in upper extremities and lower extremities bilaterally. there is no ankle clonus. plantar responses are mute. on sensory examination she is intact to light touch, pinprick, temperature and joint position of all extremities. on the gait examination she had narrow base gait. imaging: ct of the head at shows no obvious hemorrhage. hospital course: patient was had another lumbar puncture done in the emergency room at . opening pressure was 9 cm water which was normal. she has 518 red cells and the first two which decreased to 379 red cells in the fourth tube. there were three white cells with 35 percent neutrophils, 58 percent lymphocytes, 7 percent monocytes. protein was normal at 15, glucose normal at 56. an mri-mra was done which revealed no evidence of aneurysm or infarct. she did have a temperature of 100.4 and complained of some paraspinal tenderness around the l4. at the encouragement of her primary care doctor, an mri of the thoracic and lumbar spine was done revealing no evidence of epidural abscess. patient's headaches were managed with morphine and percocet and later switched over to percocet given the nausea secondary to the morphine. she was also given reglan and compazine for her nausea. after four days of hospitalization, patient was taken by the anesthesiology pain service for a lumbar puncture and blood patch under fluoroscopy. the cerebrospinal fluid taken at this time showed 10 white cells with 84 percent lymphocytes and 1 percent neutrophils. there were 689 red cells, protein 46 and glucose of 49. given that the patient still had some persistent red cells in her spinal fluid, we could not definitively rule out a subarachnoid hemorrhoid or aneurysm. patient was then taken to angiography which revealed an intracranial dissecting right vertebral artery aneurysm proximal to the vertebrobasilar junction. she was then transferred over to the neurosurgery service for management of the aneurysm. upon transfer the diagnosis was a right vertebral dissecting aneurysm. transfer condition: stable. transferred to neurosurgery on . dr., 14-133 dictated by: medquist36 d: 14:13 t: 15:26 job#: procedure: spinal tap incision of lung spinal tap incision of lung arteriography of cerebral arteries endovascular (total) embolization or occlusion of head and neck vessels spinal blood patch diagnoses: cerebral aneurysm, nonruptured multiple sclerosis 

Answer: The patient is high likely exposed to