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: lisinopril / plavix attending: chief complaint: left sided weakness major surgical or invasive procedure: iv-tpa history of present illness: ms. is a 72 yo left handed woman with a history of pvd, diabetes, hypertension and hyperlipidemia who presents this morning following sudden onset left sided weakness. the patient reports she felt well this morning, better than she has in months. she was in her kitchen at around 9am when she suddenly fell to the ground and found her left side to be weak. she denies hitting her head and states she basically just slumped on to her backside without any injury. ems was called and she was brought to . upon arrival, a code stroke was called. initial evaluation revealed left sided weakness, sensory neglect, right gaze preference and dysarthria. ct of the head was without evidence of bleed or mass; cta and ct perfusion were suggestive of a right mca occlusion. the risks and benefits where discussed and the decision to give tpa was made. currently, the patient denies headache, loss of vision, blurred vision, diplopia, dysarthria, dysphagia, lightheadedness, vertigo, tinnitus or hearing difficulty. denied difficulties producing or comprehending speech. she reports weakness of the left side and notes her left hand is numb. she denies bowel or bladder incontinence or retention. denied difficulty with gait. on general review of systems, the patient denied recent fever or chills. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. past medical history: -htn -hyperlipidemia (hdl 50s and ldl 50s-70s on simvastatin 40) -heavy chronic smoking history -type ii diabetes (recent a1cs are in good range 6-7% on home metformin monotherapy after weight loss of 40lbs last year) -chronic left great toenail fungus/removal nail bed -s/p toe amputation (necrotic), c/b popliteal dvt (was tx with warfarin a/c until suffering a lgib (hgb 5) in , polyps removed, hgb stable at 9-10 since ) -appendectomy -tonsillectomy social history: ppd cigarettes, formerly 3/4-1ppd for 50 years (tried quitting with patch, chantix, cold , all without success; never tried nicotine inhalers). denies ivdu and etoh. she lives in with her husband, , who suffers from dementia. she is a retired receptionist. family history: one sister, age 66, with diabetes. one brother with diabetes. physical exam: on initial presentation to the ed: temp:97.6 hr:98 bp:117.62 resp:18 o(2)sat:98% guaiac negative general: awake, cooperative, nad. head and neck: no cranial abnormalities, no scleral icterus noted, mmm, no lesions noted in oropharynx ******* a hematoma over the left temple near the orbit was noted to be forming during this exam, pressure was applied. neck: supple, no carotid bruits appreciated. no nuchal rigidity pulmonary: lungs clear to auscultation bilaterally cardiac: regular rate and rhythm, normal s1/s2. no murmurs, rubs, or gallops appreciated. abdomen: soft, non-tender, normoactive bowel sounds, no masses or organomegaly noted. extremities: 2+ radial pulsed. left great toe amputated skin: no rashes, bandaged cut on the left anterior foot, 2nd toe with necrotic ulcer. neurologic: -mental status: alert, oriented x 3. able to relate history without difficulty. attentive. language is fluent with intact repetition and comprehension. normal prosody. there were no paraphasic errors. pt. was able to name both high and low frequency objects. able to read without difficulty. speech was initially dysarthric but this improved over the course of the formal exam. the pt. had good knowledge of current events. there was no evidence of apraxia. there was a right sided gaze preference but no clear visual neglect, calculations intact. -cranial nerves: i: olfaction not tested. ii: perrl 3 to 2mm and minimally reactive. visual fields full on bedside confrontation testing. funduscopic exam revealed no papilledema, exudates, or hemorrhages. iii, iv, vi: eomi without nystagmus. normal saccades. v: facial sensation intact to light touch. vii: mild partial left facial droop viii: hearing intact to finger-rub bilaterally. ix, x: palate elevates symmetrically. : 5/5 strength in trapezii and sternocleidomastoid bilaterally. xii: tongue protrudes in midline. -motor: normal bulk, increased tone in the le bilaterally. initial left pronator drift but able to sustain antigravity x 5 second. no rigidity. no adventitious movements, such as tremors, noted. no asterixis. delt bic tri wre ffl fe io ip quad ham ta edb l 5 5 5 5 5 5 5 5 5 5 5 5 5 r 5 5 5 5 5 5 5 5 5 5 5 5 5 5 (formal strength testing conducted post imaging and tpa) -sensory: does not appreciate light touch or vibratory sense on the left arm and leg, but reports feeling pinprick, cold sensation. right sided sensation intact. diminished proprioception to the knees bilaterally. extinction to double simultaneous stimuli on the left. -deep tendon reflexes: tri pat ach l 3 3 3 0 0 r 3 3 3 0 0 plantar response was extensor on the right, but the left was amputated -coordination: initially clearly ataxic on left on fnf but this improved on repeat exam. mild action tremor bilaterally. -gait: deferred pertinent results: 01:25am blood triglyc-147 hdl-56 chol/hd-3.0 ldlcalc-83 11:09am blood %hba1c-6.8* eag-148* 07:35am blood albumin-4.4 calcium-9.5 phos-4.6* mg-1.5* 07:35am blood glucose-189* urean-18 creat-0.6 na-137 k-4.8 cl-99 hco3-25 angap-18 07:35am blood alt-11 ast-16 alkphos-52 totbili-0.3 01:25am blood ctropnt-0.01 07:35am blood pt-12.8 ptt-35.0 inr(pt)-1.1 09:30am blood pt-13.0 ptt-34.0 inr(pt)-1.1 07:35am blood wbc-8.6 rbc-4.40 hgb-9.7* hct-30.2* mcv-69* mch-22.0* mchc-31.9 rdw-17.9* plt ct-377 01:25am blood wbc-9.2 rbc-4.46 hgb-9.7* hct-30.5* mcv-69* mch-21.7* mchc-31.7 rdw-18.3* plt ct-332 09:30am blood wbc-7.3 rbc-4.80 hgb-10.4* hct-33.5* mcv-70* mch-21.6* mchc-31.0 rdw-18.0* plt ct-358 12:46pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-neg 10:05am urine rbc-0-2 wbc-0-2 bacteri-occ yeast-none epi-0-2 nchct / cta / ct-perfusion on presentation at ed : 1. right middle cerebral artery inferior division infarction. 2. bilateral atherosclerosis involving the origin of the internal carotid arteries with 70% of stenosis on the left and 40% stenosis on the right. 3. enlarged left thyroid lobe with multiple hypodensities. if further evaluation is desired, dedicated ultrasound can be performed. mri/mra brain 11/4-5: findings: there is no intracranial hemorrhage. there is slow diffusion involving the right parietal and right insular cortex and right external capsule in keeping with acute infarct. there is no intracranial mass, mass effect or shift of midline structures. there is slight asymmetry of the lateral ventricles. there is a background of mild microangiopathic small vessel disease involving the subcortical and deep white matter and brainstem. impression: acute infarct in the right mca distribution.no hemorrhage or mass effect. nchct at 24h post-tpa on : impression: 1. subtle hypodensity along the right insula and right frontal lobe, corresponds to evolving right middle cerebral artery infarction. 2. no evidence of acute hemorrhage. tte : the left atrium is mildly dilated. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is low normal (lvef 50%). the right ventricular free wall is hypertrophied. right ventricular chamber size is normal. with borderline normal free wall function. the aortic valve is not well seen. there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , the left ventricular ejection fraction is somewhat lower. severe pulmonary hypertension is now measured, but the technically suboptimal nature of both studies precludes definitive comparison. brief hospital course: mrs. responded well to iv-tpa given in the ed within one hour of the onset of her stroke symptoms, as detailed above. mri (dwi/adc imaging) confirmed a small acute infarcted territory in the right-mca (inferior m2 division) distribution. this territory involved the lateral post-central gyrus and the right posterior insular cortex (also seen as hypodense cortex on the 24h follow-up nchct, which confirmed that there was no intracerebral hemorrhage after tpa administration). her h&h were stable. she had a small bruise on the left side of her head and a raccoon-eye hematoma on the left, presumably from falling at the onset of her stroke sx, which remained stable after tpa. she cleared her speech and swallow and physical therapy evaluations with flying colors. tte was negative for vegetation or thrombus. we did not get a tee due to her refusal to take warfarin even if postitive. right carotid had 40% stenosis (left 70%). given the location of her stroke, involving the right insula, we were concerned for autonomic/cardiac complications, but her ecg was unconcerning for new ischemic changes and her telemetry monitoring did not reveal any concerning rhythms over >48h and her troponin-is were negative times two. she has minimal remaining stroke symptoms, including decreased sensation to light touch and pinprick on the left (possibly with a component of left sensory neglect) as well as diminished joint-position sense. problem with fluency/repetition//speech. a little lisp, but no dysarthria. no weakness detectable on exam. her flp was notable for a good hdl of 50 and ldl of 83, slightly above goal (less than 70 for diabetic pt), so her simvastatin was increased from 40mg to 80mg. she was started on aggrenox for antiplatelet therapy for prevention of stroke recurrence (she has a documented plavix allergy, rash). she was counseled by dr. of neurology regarding smoking cessation to prevent further vascular diseases including stroke, mi, pad. she was sent home with a prescrition for nicotine inhalers to replace cigarettes if she desires. she will call her outpatient pcp and dr. office for follow-up asap and in 4-8weeks, respectively. medications on admission: albuterol sulfate 90 mcg - 2 puffs q 4-6 h prn atenolol - 25 mg tablet - one tablet(s) by mouth once daily duloxetine 1 capsule(s) by mouth twice a day fluticasone 110 mcg/actuation aerosol - 2 puffs hydrochlorothiazide - 25 mg daily latanoprost 0.005 % drops ou daily metformin - 1000mg + 500mg daily omeprazole - 40 mg capsule daily simvastatin - 40 mg tablet daily valsartan - 80 mg aspirin - 81 mg daily omega-3 fatty acids 1,200 mg-144 mg capsule - discharge medications: 1. fluticasone 110 mcg/actuation aerosol sig: one (1) puff inhalation (2 times a day). disp:*0 0* refills:*0* 2. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 4. omega-3 fatty acids capsule sig: one (1) capsule po bid (2 times a day). 5. metformin 500 mg tablet sig: two (2) tablet po bid (2 times a day). 6. metformin 500 mg tablet sig: one (1) tablet po daily (daily). 7. dipyridamole-aspirin 200-25 mg cap, multiphasic release 12 hr sig: one (1) cap po bid (2 times a day) as needed for stroke. disp:*60 cap(s)* refills:*2* 8. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily) as needed for stroke, dm; ldl was 83 (>70): this is an increase in your dose from 40mg previously because your ldl cholesterol was 83, which is greater than 70, which it should be below because you have diabetes. disp:*60 tablet(s)* refills:*2* 9. nicotine 10 mg cartridge sig: one (1) cartridge inhalation q1h as needed for nicotine cravings: please use this to replace cigarrette smoking. disp:*168 cartridges (one package)* refills:*2* discharge disposition: home discharge diagnosis: stroke, right inferior mca (m2) s/p iv-tpa with significant improvement. discharge condition: aox3. full power in all muscles/extremities. no more major hemisensory deficits or extinction to dss (seems to be back to baseline). mild dysmetria on left on fnf. afebrile/hds/vss. gait normal and steady. discharge instructions: you were brought to the hospital for a stroke on the right side of your brain. you were given a powerful blood-thinning medication called t-pa. your stroke symptoms were greatly reduced shortly after the medication began, and your residual symptoms are a slight sensory change on the left side of your body. followup instructions: call your pcp for appointment asap. please call the vascular (stroke) clinic for an appointment in 4-8weeks. please call asap: provider: , md phone: md procedure: injection or infusion of thrombolytic agent diagnoses: unspecified essential hypertension chronic airway obstruction, not elsewhere classified other and unspecified hyperlipidemia atherosclerosis of native arteries of the extremities, unspecified cerebral artery occlusion, unspecified with cerebral infarction other toe(s) amputation status hemiplegia, unspecified, affecting unspecified side diabetes with peripheral circulatory disorders, type ii or unspecified type, not stated as uncontrolled 

Answer: The patient is high likely exposed to