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 / codeine attending: chief complaint: muteness, right sided weakness major surgical or invasive procedure: intra-arterial tpa administration history of present illness: the patient is a 53 year old woman with multiple vascular risk factors now presenting with acute onset muteness and right sided weakness. the patient is unable to give a history so the story is taken from family. the patient has been in her usual state of health until today. the husband tells me around 5:50 pm, she told him she was hungry. she was lying on the couch. he went outside for about 20 minutes and when he returned at 6:10 he found her still lying on the couch, unresponsive, starring to the left and not moving her right side. he tried to shake her and "snap" her out of this state. when he was unsuccessful, he called ems who arrived about 20 minutes later. she arrived at at 7:10 pm and a code stroke was activated. neurology arrived at the bedside within 30 seconds. she had a left gaze preference, decreased movement on the right and a right facial droop. she was intubated after vomiting x1 on the stretcher. she was taken to ct scan which reveal a hyperdense right mca. she was transported back to the ed and preparations were made to admininster tpa. past medical history: 1. cad - pmibi ( negative ekg changes, no cp, no perfusion defects, ef 70%) 2. diastolic chf, 2+ mr 3. hypertension 4. diabetes mellitus type ii 5. hepatitis c - untreated 6. cervical cancer - s/p tah/bso/peritoneal washing for adnexal masses 7. abdominal aortic aneurysm repair in with 8. s/p chole 9. pvd: aorto/fem bypass then with thrombectomy and patch angioplasty of common femoral arteries in 10. iv drug abuse - quit methadone program. actively using now. 11. asthma/chronic obstructive pulmonary disease / emphysema 12. total body pain 13. abdominal pain with adhesions social history: smokes ppd x 35 yrs denies etoh history of heroin use, on methadone family history: no diabetes; mi (dad-?age); heart disease (brother - quintuple bypass); htn (dad); cancer (breast-aunt; lung-brother); depression (mom, dad). physical exam: exam on admission: vitals: 98.6 150/80 88 16 general: woman vomiting on stretcher neck: supple lungs: clear to auscultation cv: regular rate and rhythm abdomen: non-tender, non-distended, bowel sounds present ext: warm, no edema neurologic examination: awake, alert, not following any commands; decreased blink to threat on right, left gaze preference, right facial droop; right side more flaccid; spontaneous mvt on left, none on right, no w/d to noxious stimuli on right leg, slight w/d on right arm, reflexes 2+ and symmetric, toe up on the right pertinent results: 11:49pm glucose-133* urea n-16 creat-0.5 sodium-136 potassium-4.3 chloride-100 total co2-25 anion gap-15 11:49pm calcium-8.7 phosphate-4.3 magnesium-1.8 11:49pm wbc-13.1* rbc-3.64* hgb-9.9* hct-28.6* mcv-79* mch-27.2 mchc-34.6 rdw-14.9 11:49pm plt count-406 11:49pm pt-15.2* ptt-38.3* inr(pt)-1.4* 09:39pm %hba1c-6.3* -done -done 07:42pm glucose-97 lactate-1.5 na+-139 k+-3.1* cl--105 tco2-29 07:25pm urea n-17 creat-0.5 07:25pm alt(sgpt)-17 ast(sgot)-14 ld(ldh)-279* ck(cpk)-28 alk phos-203* amylase-33 tot bili-0.4 07:25pm lipase-30 07:25pm ck-mb-notdone ctropnt-0.02* 07:25pm albumin-3.4 cholest-70 07:25pm triglycer-82 hdl chol-40 chol/hdl-1.8 ldl(calc)-14 07:25pm tsh-0.31 07:25pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 07:25pm wbc-12.6* rbc-3.70* hgb-9.8* hct-29.8* mcv-80* mch-26.5* mchc-33.0 rdw-14.7 07:25pm pt-14.1* ptt-26.9 inr(pt)-1.2* 07:25pm plt count-362 07:25pm fibrinoge-486* * * * ct/cta of head non-contrast head ct scan: there is a hyperdense left middle cerebral artery concerning for hyperdense clot. there is subtle hypodensity and effacement of portions of the left temporal lobe consistent with acute infarction. there is no evidence of intracranial hemorrhage or mass effect. there is no hydrocephalus. the osseous structures are unremarkable. the visualized paranasal sinuses and mastoid air cells are well aerated. impression: 1. hyperdense left middle cerebral artery with subtle hypodensity in the left temporal lobe with focal effacement consistent with acute infarction. cta head: there is calcific atherosclerotic disease of both internal carotid arteries. a thrombus is seen at the level of the left supraclinoid internal carotid artery and there is no opacification of the left middle cerebral or anterior cerebral arteries. the right anterior circulation is unremarkable. the vertebrobasilar arteries as well as both posterior cerebral arteries are patent. impression: 1. clot at the level of the left supraclinoid internal carotid artery. this results in occlusion of the left anterior cerebral and middle cerebral arteries. note added at attending review: there is poor opacification of the vasculature throughout the left middle and anterior cerebral artery territories suggesting infarction in this region. * * * cxr: single portable ap supine chest radiograph: the patient is status post median sternotomy, skin staples are still seen in the midline. the endotracheal tube is 3.3 cm above the carina. og tube tip is not visualized but is below the diaphragm. there are bilateral perihilar opacities as well as increased interstitial markings. cardiomegaly. there are bilateral pleural effusions. impression: 1. pulmonary edema 2. endotracheal tube and orogastric tube in appropriate positions. * * * ia-tpa procedure: procedure: following written informed consent from the patient's family, the patient was positioned supine on the angiography table. potential risks of the procedure discussed with the family included hemorrhage/bleeding from a portion of the body including the brain, worsened stroke, lack of successful treatment, death, vessel injury, and need for surgery. preprocedure timeout was performed to confirm patient, procedure, and site. standard sterile prep and drape of the inguinal regions bilaterally. local anesthesia with 7 cc of 1% lidocaine subcutaneously in the right inguinal region. general anesthesia was administered by the anesthesiology service. using combination of palpatory and fluoroscopic guidance, a 19-gauge single wall puncture of the right limb of the patient's aortobifemoral bypass graft was performed. a 0.035-inch guidewire was advanced through the needle into the abdominal aorta using fluoroscopic guidance. needle was exchanged for a 6-french vascular sheath, which was attached to continuous heparinized saline flush. using a 6- french mpd catheter, the left common carotid artery was selected and common carotid arteriography was performed. the catheter was then advanced into the left internal carotid artery. the microcatheter and microwire were used to attempt to gain access to the thrombus/embolus. the catheter was positioned at the trailing edge of the embolus. based on the findings of a diagnostic arteriogram, it was determined the patient may benefit from was a suitable candidate for intraarterial thrombolysis. a total of 4 mg of intraarterial tpa was administered from this catheter position in divided doses of 1 mg each. note that the patient already received a maximal dose of intravenous tpa. no effect was noted from the intraarterial tpa. on comparison between the diagnostic arteriogram and the previously performed ct arteriogram there was no change in the clot burden between the two studies accounting for differences in technique. at this point, it was determined that further intervention was likely to carry more risk and benefits. at this point, the case was discussed with the patient's family and dr. of neurology. based on these discussions, the procedure was terminated. all wires and catheters were removed. the sheath was sutured in place with a single 0 silk suture and a sterile transparent dressing was applied. the sheath was going to be transitioned from continuous heparinized saline flush to pressure transduction by the intensive care unit. the patient was transferred to the intensive care unit in stable condition. there were no immediate complications. 100 ml of optiray 240 radiographic contrast was utilized. findings: there is complete occlusion of the supraclinoid internal carotid artery on the left. the downstream portion of the left common carotid artery is patent. mild irregularity at the left carotid bulb consistent with the known atherosclerotic plaque seen on a prior ultrasound of . impression: complete occlusion of the supraclinoid internal carotid artery. a microcatheter was placed in the thrombus/embolus and 4 mg of intraarterial tpa was administered into the thrombus. * * * cxr: single view chest, ap: the et tube is slightly high lying with the tip approximately 1 cm above the superior margin of the clavicles. there has been interval increase in the size of the bilateral pleural effusions. interval placement of a left subclavian cvl is seen with the tip in the superior svc. there is no pneumothorax. persistent perihilar haziness is consistent with pulmonary edema. the patient is status post median sternotomy and cabg. impression: 1. worsening bilateral pleural effusions. 2. left subclavian cvl tip terminates at the junction of the brachiocephalic veins. no pneumothorax. * * * head ct: findings: there is significant interval increase in contralateral midline shift, now 14 mm compared to 6 mm yesterday. the left lateral ventricle in its entirety is almost completely effaced. there is increase in size of the right lateral ventricle in particular, the posterior and temporal concerning for the interval development of obstructive hydrocephalus due to compression of the foramen of . there is also new effacement of the basal cisterns on the right consistent with uncal herniation. there is heterogeneity within the large left aca territorial infarct which may represent a component of hemorrhage, however there appears to be no significant interval change compared to the appearance yesterday. again noted is the dense left mca consistent with thrombus. impression: 1. significant interval worsening. increased subfalcine herniation and new right-sided uncal herniation. interval increase in size of right lateral ventricle indicating foramen obstruction from subfalcine herniation. 2. heterogeneity in the density within the infarcted territory with increased density in the medial aspect which may represent petecheal hemorrhage into the infarcted area. 3. the pertinent findings have been discussed immediately with dr. and the necessity for immediate neurosurgical intervention, if the patient is considered salvageable has been discussed. brief hospital course: the patient is a 53 year old woman with a history of cad s/p recent cabg and porcine valve (mitral) surgery now presenting with acute onset anterior global aphasia, right sided weakness. her head ct shows a hyperdense right mca. she is getting tpa and will go to the neuro icu for further management. we will repeat her head ct one hour after tpa and if still has hyperdense right mca, will take her to angio. summary of plan: 1. will give tpa and repeat head ct in one hour, if still shows hyperdense sign, will take her for intra-arterial tpa 2. let blood pressure autoregulate 3. will check stroke risk factors, lipids, ha1c 4. will check a tte * * * after obtaining informed consent from her family, ms. was brought to interventional radiology where she was found to have complete obstruction of the left supraclinoid ica. 4 mg of intra-arterial tpa was administered but the thrombus failed to lyse. ms. was then brought to the intensive care unit for further monitoring and care. for the first 36 hours her physical exam was stable, in that when she was not sedated she remained mute, but opened her eyes to sternal rub. she moved the left side spontaneously but her right leg had no movement, and she would weakly extend her right arm to noxious stimuli. her chest x-rays revealed pulmonary edema, and her fluids were adjusted to achieve an overall negative fluid balance. on am her pupillary exam changed, so that her left pupil became dilated and minimally reactive. a repeat head ct revealed "significant interval worsening. increased subfalcine herniation and new right-sided uncal herniation. interval increase in size of right lateral ventricle indicating foramen obstruction from subfalcine herniation." as well as evidence of petechial hemorrhage into the infarct. she was administered mannitol at this time. a family meeting was held, and due to her poor prognosis for survival and for return of function, her family decided to forego any neurosurgical intervention and instead to institute comfort measures only. she was extubated and all treatments were discontinued. she died on . medications on admission: -asa 81 -docusate -protonix -trazodone -methadone -metoprolol -furosemide -nicotine patch discharge medications: none discharge disposition: expired discharge diagnosis: stroke discharge condition: deceased discharge instructions: none followup instructions: none md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances injection or infusion of thrombolytic agent diagnoses: congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified unspecified viral hepatitis c without hepatic coma coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status acute respiratory failure heart valve replaced by transplant cerebral artery occlusion, unspecified with cerebral infarction diastolic heart failure, unspecified 

Answer: The patient is high likely exposed to