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: novocain attending: chief complaint: left sided weakness major surgical or invasive procedure: iv tpa before arrival at this hospital history of present illness: 87 yo rhf with past medical history of afib off coumadin for past week for colonoscopy, htn,hl,ar, chf p/w acute onset left sided weakness at 3:15 p.m. she was in usoh till 3:00 p.m. today and was seen by her son at 3:15 p.m. while eating to have acute onset weakness on the left side, noticed due to her food dribbling down on the left side of her face. ems was called and she was taken to at 3:26 p.m. and was found to have dense left hemiplegia, hemineglect and left visual field cut. head ct showed a dense rmca m1 thrombus extending up to m2. she received iv tpa starting at 4:29 p.m. and received the full dose. she then started complaining of mild right sided headcahe () which persisted. she was then transferred to for evaluation for possible neurointerventional procedure. on neuro ros, the pt denies headache, loss of vision, blurred vision, diplopia, dysarthria, dysphagia, lightheadedness, vertigo, tinnitus or hearing difficulty. denies difficulties producing or comprehending speech. denies focal weakness, numbness, parasthesiae. no bowel or bladder incontinence or retention. denies difficulty with gait. on general review of systems, the pt denies recent fever or chills. no night sweats or recent weight loss or gain. denies cough, shortness of breath. denies chest pain or tightness, palpitations. denies nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denies arthralgias or myalgias. denies rash. past medical history: -afib previously on coumadin, but held for colonoscopy on (for 1 week now) -htn -hl -moderate aortic regurgitation -pda -chf ef 55-60% -h/o syncope -hypothyroidism -polymylagia rheumatica social history: lives independently and is fully functional at baseline. retired secretary, drives a car. has very involved children. denies tobacco, occasional alcohol. family history: father died at age 75 of cad, mother died at 95 of chf, brothers with cancer, daughter with lymphoma. physical exam: vitals: t: af p:86 (afib) r: 16 bp: 146/102 sao2: 99%ra general: eyes closed, arouses to voice, cooperative, nad heent: nc/at, no scleral icterus noted, mmm, no lesions noted in oropharynx neck: supple, no carotid bruits appreciated. no nuchal rigidity pulmonary: lungs cta bilaterally without r/r/w cardiac: irregularly irregular. abdomen: soft, nt/nd extremities: wwp skin: bruises/ecchymoses noted in bilateral arms, with large skin tear on left elbow. neurologic: (if applicable) nih stroke scale score was: 14 1a. level of consciousness: 0 1b. loc question: 0 1c. loc commands: 0 2. best gaze: 2 3. visual fields: 2 4. facial palsy: 1 5a. motor arm, left: 3 5b. motor arm, right: 0 6a. motor leg, left: 2 6b. motor leg, right: 1 7. limb ataxia: 0 8. sensory: 1 9. language: 0 10. dysarthria: 0 11. extinction and neglect: 2 -mental status: alert, oriented to name, month, and . drowsy, and dozes off when not being questioned. speech is fluent in conversation. there were no paraphasias. only able to report "chair" and read the word "room" on stroke card, which are the farmost right items, demonstrating dense neglect vs hemianopia. speech was not dysarthric. able to follow both midline and appendicular one-step commands. dense visual, sensory, and auditory neglect. -cranial nerves: i: olfaction not tested. ii: perrl 4 to 2mm and brisk. does not btt in left visual field in either eye. funduscopic exam deferred. iii, iv, vi: forced gaze deviation to r that does not cross midline. no nystagmus noted. v: facial sensation intact to light touch. vii: left facial paresis w nlf and inability to close l eye. viii: hearing intact to finger-rub bilaterally. ix, x: palate elevates symmetrically. : 5/5 strength in trapezii and scm bilaterally. xii: tongue protrudes in midline. -motor: normal bulk, decreased tone on left. moves lle in plane of bed but is unable to lift antigravity. withdrawal response to pain in lue. right sided extremities are antigravity. -sensory: senses light touch reliably on right; sometimes when left side is touched, she states she feels it on the right, othertimes she does not feel it at all. again sensory neglect is profound. -dtrs: tri pat ach l 1 1 1 1 0 r 1 1 1 1 0 plantar response was upgoing on the left. -coordination: no gross dysmetria when reaching out w right hand. -gait: deferred. ********** laboratory data: pertinent results: 02:58am blood wbc-8.1 rbc-4.12* hgb-12.6 hct-38.5 mcv-93 mch-30.6 mchc-32.7 rdw-15.4 plt ct-157 02:58am blood pt-11.2 ptt-25.2 inr(pt)-1.0 02:58am blood pt-11.2 ptt-25.2 inr(pt)-1.0 02:58am blood glucose-119* urean-15 creat-0.7 na-133 k-3.8 cl-99 hco3-26 angap-12 02:58am blood ck-mb-1 ctropnt-<0.01 02:58am blood triglyc-99 hdl-57 chol/hd-2.5 ldlcalc-66 02:58am blood %hba1c-5.6 eag-114 06:20am blood digoxin-0.4* ct/cta/ctp no acute intracranial hemorrhage. 2. ct perfusion study suggests acute infarctions in the superior right middle cerebral artery territory and in the right posterior cerebral artery territory. these are not yet detectible on the conventional ct images, with only a small focus of mild cytotoxic edema noted in the right anterior insula. 3. large thrombus extending from the distal right common carotid artery into the proximal right internal carotid artery with 99% stenosis. this thrombus also extends into and completely occludes the proximal right external carotid artery, which demonstrates distal reconstitution, most likely via retrograde filling through its branches. 4. occlusion of the superior division of the right middle cerebral artery. 5. bilateral fetal configuration of posterior cerebral arteries. the posterior communicating arteries appear patent bilaterally. 6. enlarged and multinodular thyroid. this may be further evaluated by , if not previously performed elsewhere. mri/mra head and neck 1. large acute infarctions involving the right frontal lobe, insula, and temporal lobe in the middle cerebral artery territory and the right occipital lobe in the posterior cerebral artery territory. 2. focal hemorrhagic transformation in the posterior right temporal lobe. 3. motion-limited mras of the head and neck demonstrate no appreciable change from the preceding ctas of the head and neck. there is a large thrombus extending from the distal right common carotid into the proximal right internal carotid and external carotid arteries, with 99% stenosis of the right internal carotid artery, better demonstrated on the cta, and complete occlusion of the proximal external carotid artery (with reconstitution via retrograde filling). persistent occlusion of the superior division of the right middle cerebral artery. bilateral fetal posterior cerebral arteries with bilateral patent posterior communicating arteries. echocardiogram: patent ductus arteriosus. mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. moderate to severe tricuspid regurgitation. pulmonary artery hypertension. mild aortic valve stenosis. mild aortic regurgitation. dilated ascending aorta. cta neck :interval decrease in size of the thrombus in the right common carotid artery extending into both the internal and external branches. a small amount of thrombus is still present. 2. the previously seen occlusion of the superior division of the right mca is not completely included in the field of view of today's study given that the study is a neck cta. if there is any clinical concern for continued occlusion, recommend a dedicated cta of the head for further evaluation. 3. worsening pulmonary edema with bilateral pleural effusions. brief hospital course: the patient is an 87 y/o with past medical history of afib off coumadin for pastweek for colonoscopy, htn,hl,ar, chf p/w acute onset left sided weakness and found to have left hempiplegia and profound neglect consistent with r mca syndrome. neuro: at a dense mca sign was seen on imaging, and the pt received iv tpa at 90 min after onset of symptoms. nihss was slightly improved here to 14 from 17 at . the patient had a cta head and neck here which revealed recanalization of the r mca with cutoff seen at r m2 superior division and evidence of thrombus at the r cca occluding 99%, extending to r eca and r ica with recanalization distally. endovascular intervention was discussed with the neurointerventional attending as well as stroke attending, dr. and the decision was made that the risk of attempting recanalization of the r cca thrombus could potentially outweigh the benefit given the risk of distal embolization with manipulation, and relatively intact blood supply currently to circle of . the patient had a mri head which showed large acute infarctions involving the right frontal lobe, insula, and temporal lobe in the middle cerebral artery territory and the right occipital lobe in the posterior cerebral artery territory as well asa focal hemorrhagic conversion. the patient was briefly placed on a heparin drip despite this due to concern for the right carotid occlusion. this was later discontinued when the patient had a headache due to concern for bleed. ct head was obtained 24hours after tpa and showed no progression of hemorrhagic conversion noted on mri the previous day. the patient remained in the icu overnight and then was transferred to the floor the following day. she was started on aspirin and then restarted on coumadin. the patient regained some left sided strength and her left sided neglect improved slightly. while on the floor she began to open her eyes spontaneously and answered questions appropriately. a repeat cta of the neck showed decreased thrombus of the right common carotid. cardiac: the patient was monitored on telemetry and remained in atrial fibrillation. her cardiac enzymes were negative. she was continued on metoprolol at lower doses initially and home antihypertensives were held to allow for autoregulation. her heart rate trended up and her metoprolol was increased to her home dose. as above, she was started on aspirin bridge to coumadin. echocardiogram revealed a pfo. endocrine: her fingersticks were checked and she was placed on sliding scale insulin. glycohemoglobin was normal and ldl cholesterol was <100. fen: the patient was not able to swallow safely so a ng tube was placed and tube feeds begun on . on the patient was cleared to start ground solids and nectar thickened liquids. her tube feeds were held during the day and the plan is to continue nightly tube feed until she is able to take in an adequate number of calories. infection: the patient was noted to be delerious on and ua came back positive. she was started on ceftriaxone for uti, urine culture pending at this time. once antibiotics were started her delerium cleared. 1. dysphagia screening before any po intake? (x) yes - () no 2. dvt prophylaxis administered? (x) yes - () no 3. antithrombotic therapy administered by end of hospital day 2? (x) yes - () no 4. ldl documented? (x) yes 5. intensive statin therapy administered? (for ldl > 100) () yes - (x) no (if ldl >100, reason not given: ) 6. smoking cessation counseling given? () yes - () no (reason (x) non-smoker - () unable to participate) 7. stroke education given? (x) yes - () no 8. assessment for rehabilitation? (x) yes - () no 9. discharged on statin therapy? (x) yes - () no (if ldl >100, reason not given: ) 10. discharged on antithrombotic therapy? x() yes (type: (x) antiplatelet - (x) anticoagulation) - () no 11. discharged on oral anticoagulation for patients with atrial fibrillation/flutter? (x) yes - () no - () n/a medications on admission: preadmission medications listed are correct and complete. information was obtained from family/caregiver. 1. simvastatin 40 mg po daily 2. lisinopril 40 mg po daily 3. warfarin md to order daily dose po daily16 2.5-5mg as directed 4. digoxin 0.125 mg po daily 5. levothyroxine sodium 75 mcg po daily 6. metoprolol tartrate 100 mg po bid 7. prednisone 1 mg po daily 7 tabs daily 8. docusate sodium 100 mg po bid 9. clobetasol propionate 0.05% ointment 1 appl tp discharge medications: 1. digoxin 0.125 mg po daily 2. docusate sodium 100 mg po bid 3. levothyroxine sodium 75 mcg po daily 4. prednisone 1 mg po daily 7 tabs daily 5. metoprolol tartrate 100 mg po bid 6. simvastatin 40 mg po daily 7. aspirin 325 mg po daily stop when inr 8. nystatin cream 1 appl tp 9. clobetasol propionate 0.05% ointment 1 appl tp 10. nitrofurantoin (macrodantin) 50 mg po q6h please continue through 11. warfarin 3 mg po daily16 discharge disposition: extended care facility: hospital - discharge diagnosis: right frontal, temporal and occipital lobe stroke patent foramen ovale discharge condition: oriented to date, does not believe we are at , thinks she's in hospital in . opening eyes. answers questions appropriately. naming intact. left facial droop, l hemineglect, l hemiparesis (antigravity). increased tone in left arm. localizes to pain on the left arm, withdraws to pain in left leg. toes up on left and down on right. bibasilar crackles in lungs, improved. discharge instructions: dear ms , you were admitted for a stroke. this was thought to be secondary to your atrial fibrillation. you were restarted on coumadin for stroke protection. your stroke risk factors were checked. you should continue to not smoke. your ldl cholesterol was 66. you were continued on a statin. you had a cardiac echocardiogram which demonstrated no cardioembolic source, but did show a patent foremen ovale. you were checked for blood glucose control with a hgb a1c. the level was 5.6 which is normal. you need to continue your blood pressure control. you should continue to eat a low fat healthy diet, and follow up with your primary care physician and stroke neurology as detailed below. it was a pleasure taking care of you. followup instructions: please follow up provider: , : date/time: 11:00 provider: (neurology) , md phone: date/time: 10:00 provider: , md phone: date/time: 1:30 md, procedure: enteral infusion of concentrated nutritional substances diagnoses: polymyalgia rheumatica mitral valve disorders urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension unspecified acquired hypothyroidism atrial fibrillation intracerebral hemorrhage other and unspecified hyperlipidemia do not resuscitate status encephalopathy, unspecified examination of participant in clinical trial cerebral thrombosis with cerebral infarction occlusion and stenosis of carotid artery with cerebral infarction facial weakness homonymous bilateral field defects dysphagia, unspecified flaccid hemiplegia and hemiparesis affecting nondominant side status post administration of tpa (rtpa) in a different facility within the last 24 hours prior to admission to current facility 

Answer: The patient is high likely exposed to