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: scallop attending: chief complaint: unresponsiveness major surgical or invasive procedure: none history of present illness: (obtained from transfer medical records, omr, and transfer s/o) mrs. is a 59-year-old right-handed woman with history of htn, hld, copd on home o2, chf, cervical and endometrial adenocarcinoma, paraganglioma of the left skull base s/p radiation, seizure disorder due to paraneoplastic limbic encephalitis who is transferred from osh intubated after episode of unresponsiveness for further of current presentation and skull base tumor. mrs. initially presented to osh on after having a transient (seconds to minutes) loss of consciousness. she was sitting at the dining room table with her mother when she went from alert, at baseline, to snoring respirations. she then fell off her chair to the right and lost consciousness. no activity concerning for seizure. by time ems arrived she had returned to baseline alertness. in the ed she was found to have a uti and was started on cipro and admitted. on neurology and heme/onc were consulted for the transient loc. she had had 2 prior epsiodes similar in nature in the past 6 weeks, although one of these was possibly in the setting of choking. during all 3 of these events it was unclear why she had the transient loc as she had normal eegs and ttes. on she was noted to be more confused and was hypoxic. the rapid response team was called, and after further decompensating to unresponsiveness with a o2 sat of 92% on high flow o2 (35%), she was intubated. notes indicate that blood was flowing out of the nasal trumpet. she was initially hypertensive but then required pressors for blood pressure support. she was transferred to the icu. they could find no clear cause for the decompensation. of note her inr was therapeutic at admission, decreased to 1.8 on , and then again therapeutic . it appears coumadin was continued until yesterday, when it was held for pending evaluation here of skull base tumor. on they noted that the patient was alert and could follow commands but they were unable to wean her from the vent. given concern that the skull base lesion may be contributing, they pursued transfer here as her neuro-oncologist is dr. . mrs. was seen in clinic for a putative, non-biopsy proven, paraganglioma of the left skull base, invasive. the patient has undergone radiation, without resection, of this lesion. this paraganglioma has since enlarged extending further, invasive of the left skull base and petrous temporal bone. her last brain mri was done (report in atrius) which noted that "there was a marked increase in size of the metastatic lesion in the left petrous apex bone. there is extension of the mass into the posterior fossa, the foramen magnum, and into the infratemporal fossa on the left. the lesion has increased in size from approximately 1.5 cm to 4.5 cm in size." with respect to mrs. ' oncologic history, a paraneoplastic limbic encephalitis was the first presenting suggestion of an oncologic process. she developed a complex partial seizure disorder greater than three years ago culminating in the diagnosis of a paraneoplastic limbic encephalitis with increased flair signal in both medial and temporal lobes on mri. she received one course of ivig, steroids and plasmapheresis which apparently halved the antibody titer. the primary tumor giving rise to the paraneoplastic process was not found. nonetheless, around the same time, she was diagnosed with a synchronous cervical and endometrial adenocarcinoma. the grade of the cervical carcinoma was t1n1m1,and the grade of the endometrial adenocarcinoma was grade i, t1b. she underwent resection with chemoradiation for these. the seizure disorder is characterized by complex partial seizures which do not generalize. the husband does not notice the seizures, but the daughter notices them, and these have been previously captured on eeg, per the patient. per the husband, the daughter notices a vacant look, and the patient seems spacey for a short time. early last summer, the patient began to experience difficulty swallowing. she had difficulty swallowing boluses with gagging, choking, and demonstrated projectile vomiting. soon after this, she was noted to have a hoarse voice. workup included imaging of the skull base, which included an mri in this year as a follow up set of images. the mri read from suggests "a metastatic lesion." thus, paraganglioma was considered the most likely diagnosis. she saw an ear, nose and throat surgeon at who suggested that intervention surgically would be dangerous and result in significant morbidity given the location of the tumor at the skull base adjacent to cranial nerves and great vessels. therefore, she underwent radiation treatment with the radiation to it including the left skull base and the lesion. there has been no biopsy of this lesion to demonstrate its underlying nature. she has not undergone gamma knife or proton beam therapy. she was evaluated by dr. in clinic to discuss surgical intervention or proton beam or gamma knife intervention. although hoarseness appeared almost one year ago, it has recently worsened. hoarseness had appeared last summer, improved about three months ago, and then worsened again about two months ago. at the present time, her husband, also with her on the visit today, and the patient deny a modified diet, but it does appear that the husband is giving her food that is easier to swallow at the present time. she is taking thin liquids and somewhat soft solids. she denied any difficulty swallowing recently with no choking or vomiting. of note, in clinic the patient mentions a left-sided ptosis that has appeared about two months ago. no appreciated change in sweating on the left side of the face. ros: unable, pt is intubated. past medical history: pmhx: -hypertension -hyperlipidemia -hx of traumatic sdh that did not require surgical intervention -hx of t3 vertebral fx s/p fall -paraneoplastic limbic encephalitis in resulting in seizures and some difficulty with memory. -seizure disorder (complex partial, do not generalize) -cervical and uterine cancer 2.5 years ago s/p surgery and chemoradiation -copd with chronic co2 retention; with minimal tobacco history; baseline bicarb 36; able to walk about 40 to 50 feet, meaning that she can get to and from the kitchen and to his car without difficulty. -chf (unknown ef) -morbid obesity -hypercoaguable with factor v leiden mutation and positive lupus anticoagulant - hx pulmonary embolism, on lifelong coumadin. pshx: cholecystectomy recent herniorrhaphy social history: -she lives with her daughter and husband. the daughter and husband work alternating shifts and are able to help her home. they get no further assistance in the house or visiting nursing. -the patient previously smoked in her teens and young adult group, but this was less than one pack a day and was only for several years. quit . -she drinks no alcohol and had previously only had rare alcohol. at home, she is able to walk around as mentioned above. the patient is presently not working. -she does not use a walker, a cane, or a wheelchair at home. family history: -no lung disease, copd, seizures, or known cancers. -mother: scoliosis and hypertension. -has no siblings, attributed to rhesus compatibility, per her husband. apparently, the patient's own birth was also difficult, but they do not know further details. physical exam: physical exam on admission: vitals: t 98.5 hr 73 bp 99/31 rr 16 96% on vent: cmv 60% general: intubated, sedated, morbidly obese. heent: nc/at neck: supple pulmonary: diminshed breath sounds throughout. no wheezes, rales, rhonchi cardiac: rrr, no murmurs abdomen: soft, nontender, nondistended extremities: trace pedal edema, 1+ dps skin: no rashes or lesions. neurologic: (off proprofol for 10 minutes) -mental status: eyes open spontaneously. attends to visual stimuli. will follow simple commands axially (close eyes, stick out tongue, look right/left) but not appendicular. gaze midline, possibly r preference but will cross midline to left. intially as propofol had been off for 5 minutes, eyes were slowly bobbing vertically, which resolved spontaneously minutes later. -cranial nerves: perrl 3 to 2mm and brisk. blinks to threat bilaterally. corneals intact. full eomi to the right, unable to bury sclera on leftward gaze with 2-3 beats of fatigueable right beating nystagmus. strong gag. -motor: no spontaneous movement of extremities or movement to command. withdraws to noxious in bilateral ues, triple flexes to noxious in b/l les. no adventitious movements. -sensory: grimaces to noxious throughout -dtrs: tri pat ach l 2+ 2+ 2+ 1 2 r 2+ 2+ 2+ 1 2 plantar response was flexor bilaterally. physical exam on discharge: expired pertinent results: labs on admission: 09:20pm wbc-10.2 rbc-3.93* hgb-11.9* hct-36.3 mcv-92 mch-30.2 mchc-32.7 rdw-14.9 09:20pm pt-17.2* ptt-28.9 inr(pt)-1.6* 09:20pm fibrinoge-434* 09:20pm calcium-8.0* phosphate-4.5 magnesium-2.2 09:20pm glucose-134* urea n-14 creat-0.7 sodium-139 potassium-4.1 chloride-103 total co2-30 anion gap-10 09:26pm type-art po2-81* pco2-54* ph-7.35 total co2-31* base xs-2 intubated-intubated relevant labs: 06:18am blood ck-mb-1 ctropnt-<0.01 06:18am blood ck(cpk)-278* imaging: mri c spine 1. the left skull base mass involves the anterior and posterior elements of c1 and c2. though paravertebral expansion is present, there is no significant spinal canal encroachment, and no spinal cord compression. 2. abnormal high t2 signal in the matter of the spinal cord from the craniocervical junction through c3, with patchy associated contrast enhancement, most likely related to subacute infarction, given the presence of contiguous subacute infarction in the left lateral medulla and the left posterior inferior cerebellar hemisphere. recommend follow-up to exclude the less likely possibility of malignant involvement. 3. chronic compression deformities of t1 through t3 vertebral bodies, without evidence of associated masses. mild retropulsion at t3 does not compress the spinal cord. 4. cervical degenerative disease from c3-4 through c6-7 without spinal cord compression. multilevel neural foraminal narrowing. mri head/mra head/mri skull base 1. large infarction with hemorrhagic transformation in the left posterior inferior cerebellar artery territory, involving the cerebellar hemisphere as well as the left lateral medulla. the infarction appears to extend into the imaged upper cervical cord. 2. severe compression of the fourth ventricle. no dilatation of the third and lateral ventricles at this time. 3. 8 mm rim-enhancing leptomeningeal nodule in the left inferior parietal region, likely a metastasis. no associated edema. 4. large left skull base mass invading the clivus, petrous temporal bone, occipital bone, and the c1 vertebra. the mass abuts the carotid canal and multiple skull base foramina. the petrous carotid artery could be assessed by cta, if clinically indicated. 5. irregularity and narrowing of the distal cervical and proximal intracranial left vertebral artery at the level of the left skull base mass, where the artery is encased by the mass. brief hospital course: mrs. is a 59-year-old right-handed woman with history of htn, hld, copd on home o2, chf, cervical and endometrial adenocarcinoma, paraganglioma of the left skull base s/p radiation, seizure disorder after episode of paraneoplastic limbic encephalitis who is transferred from osh intubated after episode of unresponsiveness for evaluation of skull base tumor and recurrent episodes of unresponsiveness. # neuro: on admission exam, patient was alert, opened eyes to voice, following axial simple commands (closed eyes and opened eyes, stuck out tongue), with impaired left gaze>right and r gaze preference. corneal reflex was present on the right, but absent on the left. no motor response to noxious stimuli in ues/ /l and triple flexion to noxious stimuli in lle. per husband who is in the room, prior to hospitalization on , mrs. was able to walk without assistance, feed herself and bathe with minimal assistance. thus, quadriplegia was of new onset. this was quite concerning for metastatic or compressive involvement of the cervical cord. her presentation of at least 3 transient losses of consciousness and then a more severe unresponsiveness with is concerning for possible seizure activity vs. autonomic dysfunction vs. cardiac cause. none of the events had reports of seizure-like activity and previous cardiac work up for syncope has been unrevealing. given the location of the skull base mass and the mass effect seen on the medulla and cerebellum, it is plausible that this mass could be causing a vagal effect. we pursued further evaluation of this mass to look for potential treatment. patient with known skull base mass, seizure disorder,and several episodes of unresponsiveness. on admission, initiated 24 hour urine metanephrines and catecholamines to eval for paraganglioma. also, continued home aeds: keppra 1500mg and lacosamide 250mg bidalso, new onset quadriplegia from hospitalization on . mri c spine with invasion of skull base mass into c1, c2 also with t2 enhancement of the cord from cervicocranial junction to c3. mri head w/ subacute left posterior inferior cerebellar infarct extending into the lateral medulla with hemorrhagic conversion. severe compression of the 4th ventricle. given hemorrhagic converstion, discontinued heparin drip yesterday. eeg with no seizure activity, but did have decreased amplitude since midnight. most likely, this was c/w increasing icp. currently, on exam, patient has locked in syndrome--she is quadriplegic, only eye movements intact, but, has r iii and vi palsy as well as l vi. prognosis is extremely grim. had family meeting with husband present and son, daughter, mother on conference call on . explained to the family that, unfortunately, mrs. will not be able to make a recovery from this and that at this point, we should focus on comfort care and allow her to pass away peacefully and with dignity. family agreed. patient was extubated with plans to move to comfort measures only on at 12pm. she passed away peacefully with family at bedside at 12:05pm. # cardiac: labile bp, hx of chf with unknown ef. did have b/l pleural effusions concerning for component of chf exacerbation contributing to poor respiratory status. sbps haveranged 88-154, now off levophed. this is also likely due to autonomic dysfunction. cmo as above. # pulmonary: intubated, co2 retainer. also has b/l pleural effusions further adding to her barriers to extubation initially. extubated as above once she was made cmo. medications on admission: home meds:(per transfer paperwork) citalopram 20 mg tablet - 1 tablet(s) by mouth at bedtime furosemide 20 mg tablet - 1 tablet(s) by mouth once a day lacosamide 250 mg tablet by mouth twice a day levetiracetam 1500mg by mouth twice a day lisinopril 40 mg tablet by mouth once a day oxycodone 5 mg tablet by mouth every 6-8 hours warfarin 9 mg tablet by mouth at bedtime fentanyl patch 75 q3 days albuterol prn acetaminophen 500 mg tablet by mouth as needed for fever or pain medications on transfer: propofol gtt norepi gtt discharge medications: expired discharge disposition: expired discharge diagnosis: skull base tumor, likely paraganglioma right cerebellar infarct with hemorrhagic conversion infarct from c3 of cord extending to lateral medulla copd chf factor v leiden mutation cervical/endometrial cancer discharge condition: expired discharge instructions: expired followup instructions: expired procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours fiber-optic bronchoscopy arterial catheterization diagnoses: congestive heart failure, unspecified unspecified essential hypertension chronic airway obstruction, not elsewhere classified intracerebral hemorrhage personal history of malignant neoplasm of other parts of uterus compression of brain other and unspecified hyperlipidemia secondary malignant neoplasm of brain and spinal cord morbid obesity long-term (current) use of anticoagulants primary hypercoagulable state encounter for palliative care do not resuscitate status cerebral artery occlusion, unspecified with cerebral infarction personal history of malignant neoplasm of cervix uteri localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy secondary malignant neoplasm of other parts of nervous system quadriplegia, unspecified malignant neoplasm of bones of skull and face, except mandible unspecified disorder of autonomic nervous system vascular myelopathies locked-in state 

Answer: The patient is high likely exposed to