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: patient recorded as having no known allergies to drugs attending: chief complaint: headache major surgical or invasive procedure: : placement of left external ventricular drain : replacement of evd in the operating replacement of evd in or : ventriculo-peritoneal shunt placement(left) history of present illness: pt is a 61 yo female with pmhx sig for anxiety, depression, hypercholesterolemia, and borderline diabetes transferred from for r ich. the patient has been complaining of headaches over the last several weeks. this pm she fell to the ground for unclear reasons and was difficult to get up.husband also noticed that she was not moving the left side of her body well. she was brought to where she was found to have a 4.0 cm x 3.5 cm r basal ganglia hemorrhage with ventricular extension. she decompensated in the scanner and required intubation. she was then transferred to . past medical history: anxiety, depression, hypercholesterolemia, borderline diabetes, obesity. social history: lives with husband. on disability for anxiety and depression. two adopted children. family history: mother - cva due to carotid disease. father - yo. physical exam: physical exam: vitals: t ; bp 147/67; p 71; rr 16; o2 sat 100% on vent general: intubated, sedated heent: ncat extremities: no c/c/e. neurological exam: intubated, sedated, perrl, 4-->2mm with light, + vor, + corneal, face symmetry difficult to assess due to ventilator tube/straps. withdraws on the right purposefully to pain. does not withdraw on the l. reflexes absent at the patella and trace otherwise. exam upon discharge: afebrile, vital signs are stable. spontaneous to light noxious eye opening. lue is spontaneous, with hand gripping. rue w/draws to nail bed pressure. bilat le triple flexion to deep stimulation. upgoing toes. cranial wounds are clean dry and intact. pertinent results: labs on admission: 132 94 12 - - - - - - gluc 192 4.4 27 0.7 ca: 9.0 mg: 2.1 p: 2.0 serum asa, etoh, acetmnphn, benzo, barb, tricyc negative urine benzos, barbs, opiates, cocaine, amphet, mthdne negative wbc 16.2 hct 39.3 plt 326 pt: 12.6 ptt: 25.6 inr: 1.1 labs on discharge: xxxxxxxxxxxxxxxx ---------------- imaging: ---------------- cta head : cta of the head: the carotid and vertebral arteries and their major branches are patent with no evidence of stenoses or dissection. there is a moderate degree of atherosclerotic calcification within the cavernous portion of the icas bilaterally. there is no evidence of aneurysm formation or other vascular abnormality. impression: 1. unchanged right frontal hematoma with intraventricular extension, now status post shunt placement. minimal leftward shift of midline structures is seen, secondary to decompression of the left lateral ventricle. 2. no new focus of hemorrhage. 3. no evidence for avm or aneurysm. the carotid, vertebral and major intracranial arterial branches demonstrate no significant stenosis or dissection. head ct : impression: no significant change in the large right basal ganglia intraparenchymal hemorrhage with intraventricular extension. stable ventricular size. head ct : impression: redemonstration of large right basal ganglia bleed with surrounding edema and approximately 8 mm of right to left midline shift. redemonstration of intraventricular extension and a small amount of right temporal subarachnoid blood. mild effacement of the perimesencephalic cistern is unchanged. head ct : impression: 1. a new right frontal approach shunt catheter ends in the left periventricular white matter above the level of the thalamus, with a new focus of parenchymal hemorrhage seen adjacent to its tip. 2. no significant change in ventricular size. 3. right intraparenchymal hemorrhage with intraventricular extension, and associated mass effect, are unchanged since prior study. lenis : impression: no evidence of dvt. ct head : impression: 1. hypodense appearance of the right temporal lobe with obliteration of the -white junction most likely represents an infarct. asymmetric attenuation of the cerebellar hemispheres with right cerebellar hemisphere appearing more hypodense as compared to left, represent an infarct as well; however, evaluation is limited due to streak artifact from posterior fossa, skull and motion. 2. stable right basal ganglia and left frontal hemorrhage with a transfrontal ventricular shunt in the area of the posterior limb of internal capsule with adjacent hemorrhage. intraventricular extension of hemorrhage as well as right subarachnoid hemorrhage is also grossly stable. no definite hydrocephalus at this time. upper extrmity doppler : impression: no evidence of right upper extremity dvt. please note that this study is limited as the left subclavian vein was not imaged for comparison. cxr : findings: as compared to the previous radiograph, there is no relevant change. the tracheostomy tube and the left-sided central venous access line are in unchanged position. low lung volumes with borderline size of the cardiac silhouette but without evidence of pulmonary edema. no focal parenchymal opacities suggesting pneumonia. no evidence of pleural effusions. mra head : head mri: allowing for differences in modalities, the right frontal parenchymal hematoma appears stable in extent compared to the most recent ct scan (). the extent of associated edema in the right frontal lobe, insula, and temporal lobe is stable. leftward shift of midline structures with mild right subfalcine herniation is unchanged. the right perimesencephalic cistern is narrowed, but no uncal herniation is seen. bilateral subarachnoid hemorrhage is again noted along the convexities. interventricular extension of hemorrhage also appears stable. compression of the frontal and body of the right lateral ventricle is stable compared to . the right frontal ventriculostomy catheter remains in unchanged position, traversing the lateral ventricles and terminating in the region of the left internal capsule and left thalamus. blood products are again seen surrounding the catheter tip. the ventricles are stable in size. blood products are also again noted in the left frontal lobe, related to a prior ventriculostomy catheter, with mild associated surrounding edema. diffusion-weighted images demonstrate expected signal abnormalities corresponding to the above-described blood products. in addition, there are foci of slow diffusion unrelated to the blood products, consistent with evolving acute infarctions. these infarctions also demonstrate high signal on t2-weighted/flair images, indicating that they are at least one day old. they include small infarctions in the subcortical white matter of the superior frontal lobes (images 8:19-21, 3:23-24), in the right periatrial white matter (image 8:17), and the left lateral temporal cortex (images 8:12, 3:13), and a moderate infarction in the white matter lateral to the occipital of the left lateral ventricle (images 8:8, 3:13). there is no evidence of an acute infarction in the right temporal lobe or right cerebellar hemisphere. abnormal appearance of these regions on the most recent ct scan was likely related to motion artifacts. there is bilateral high t2 signal in the central pons and anterior midbrain, without associated diffusion abnormalities or blood products. these are nonspecific, but could be related to prior microvascular ischemia. their location is not typical for diffuse axonal injury. there is mucosal thickening and fluid in the sphenoid sinuses, as well as partial opacification of the mastoid air cells bilaterally. this could be related to prior intubation and current tracheostomy. head mra: this study is limited by motion artifacts. flow in the a1 segments of the anterior cerebral arteries, m1 segments of the middle cerebral arteries, and proximal p2 segments of the posterior cerebral arteries is poorly visualized. while these findings could be artifactual, vasospasm related to the known subarachnoid hemorrhage cannot be excluded. the right parenchymal hematoma abuts the m1 segment of the right middle cerebral artery, as before. impression: 1. multiple small evolving acute infarctions in the superior bifrontal subcortical white matter, right periatrial white matter, and left lateral temporal cortex. moderate evolving acute infarction in the left lateral occipital periventricular white matter. 2. compared to , right frontal parenchymal hemorrhage with intraventricular extension, left frontal parenchymal hemorrhage related to prior ventriculostomy, left thalamic/internal capsule hemorrhage related to the current ventriculostomy, bilateral subarachnoid hemorrhage, associated mass effect, and size of the ventricles are all unchanged. 3. the head mra is limited by motion artifacts. poor visualization of flow in the a1 segments of the anterior cerebral arteries, m1 segments of the middle cerebral arteries, and proximal p2 segments of the posterior cerebral arteries could be artifactual, but vasospasm cannot be excluded. abdominal us : impression: 1. gallbladder is unremarkable. 2. extremely increased echogenicity of the liver throughout without evidence of focal lesion. findings are consistent with fatty liver infiltration. other forms of liver disease including significant hepatic fibrosis/cirrhosis cannot be excluded on this study. ct head : findings: the right basal ganglia hemorrhage, measures 3.7 x 2.6 cm compared to prior 3.6 x 2.5 cm, relatively unchanged. there continues to be perihemorrhagic edema and mass effect causing leftward subfalcine herniation by 9.3 mm, slightly improved since the prior study. there is mild medial displacement of the right uncus without frank uncal herniation. a vp shunt via the left frontal approach is terminating in the third ventricle. trace intraventricular extension of hemorrhage is seen in the posterior of the lateral ventricle, unchanged. mild edema is seen along the previous right-sided catheter tract. unchanged hypoattenuation is present in the left parieto-occipital lobe and frontal lobe. small foci of subarachnoid hemorrhage are present along the right parieto-occipital region, unchanged (2:17). there are no new foci of hemorrhage. osseous and soft tissue structures are unremarkable. unchanged fluid is present in bilateral sphenoid air cells. impression: unchanged right basal ganglia intraparenchymal hemorrhage with 9mm leftward subfalcine herniation. no significant interval change. ct head : 1. no new foci of ich. 2. right basal ganglia hemorrhage slightly smaller in size. 3. slightly improved leftward shift, now 7mm from 9mm. 4. unchanged tiny intraventricular hemorrhage layering in the left occipital . 5. no developing hydrocephalus. 6. unchanged vp position. ***copies of three most recent head ct and chest x-rays will be provided by cd. brief hospital course: patient was admitted to the icu under dr. .she had evd placed. her exam improved and she was following commands consistently with all 4 extremities by and she was extubated. evd continued to become clogged so intrathecal tpa was initiated. shortly after the evd became clogged and could not be cleared. at this time she was taken to the operating room for replacement of the left evd catheter. this catheter again became clogged requiring a second evd replacement . post op ct showed good placement of catheter. she remained intubated and closely followed in icu. on , neurology recommendations were to discontinue her nardil for concern of pres. psychology was consulted and recommended that nardil also be discontinued and it needed phentolamine or nitroprusside could be used to control blood pressure. her exam remains poor with no eye opening to noxious stimuli, no commands. she attempts to localize with the lue, but extensor postures in the rue. she triple flexes the rle and withdraws her lle to noxious stimuli. continuous eeg was also ordered to rule out seizure activity. overnight patient spiked a fever of 101.6 and was pancultured. sputum grew 4+ gram negative rods and she was placed on vancomycin/zoysn. csf was also sent which did not grow any microorganisms. on , she had continuous eeg monitoring and continued to have a poor exam, preliminary read of the eeg is not revealing for epiliptiform acitivity. a fever work up is underway with added lenis and lfts. antibiotic coverage has been broadened with cefepime, cipro and vancomycin for ongoing fevers. on a repeat ct of the head was done, and she was noted to have new areas of hypodensity of the right temporal and cerebellar regions. this was attributed to..... on , her external ventricular drain was raised from 10cm to 15cm in an attempt to determine her need of it. she tolerated this well. on the evd was raised to 20; however, overnight, the icp rose to 20 for 5 minutes sustained. the decision was made to open the drain, and the icp subsequently dropped to the low teens. she was seen by id, who recommended we continue her current abx regimen and postulated that the elevated wbc count was likely not infectious, as she is not bacteremic and her pna has resolved. on , the evd was again clamped, but later in the day she was unable to tolerate it, as her icps again rose to above over 23. the decision was made to open the drain, and to place a permanent vps in the or on . on , she went to the operating room for a left sided ventriculoperitoneal shunt placement, which was tolerated well. post-op she was returned to the sicu for continued managment of her respiratory status. on , she was determined neurologically stable to transfer to the neurosurgery stepdown unit (pending her ability to tolerate a trach mask). she completed her treatmetn for vap, and on the overnight of , had an episode of bronchospasm and was put on albuterol and ipatropium. since that time, she had no further incidents. on she was accepted to in . she was discahrged as such, and imaging was provided to the rehab facility by cd. medications on admission: nardil 15 mg tablets (2 3/4 tablets q day), xanax,lamictal 100 mg , simvastatin 20 mg q day. discharge medications: 1. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 7 days. 2. cephalexin 500 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 7 days. disp:*28 capsule(s)* refills:*0* 3. docusate sodium 50 mg/5 ml liquid sig: two (2) po bid (2 times a day). 4. lamotrigine 100 mg tablet sig: one (1) tablet po bid (2 times a day). 5. chlorhexidine gluconate 0.12 % mouthwash sig: one (1) ml mucous membrane (2 times a day). 6. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 8. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 9. atenolol 50 mg tablet sig: one (1) tablet po bid (2 times a day): hold if sbp <110, hr<60. 10. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for itching. 11. acetaminophen 500 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever, headache. 12. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: six (6) puff inhalation q6h (every 6 hours) as needed for sob, wheezing. 13. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: six (6) puff inhalation q4h prn () as needed for wheeze. 14. white petrolatum-mineral oil 56.8-42.5 % ointment sig: one (1) appl ophthalmic prn (as needed) as needed for dry eyes. 15. alprazolam 0.25 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 16. alprazolam 0.25 mg tablet sig: one (1) tablet po qid (4 times a day). 17. levetiracetam 500 mg tablet sig: three (3) tablet po bid (2 times a day). 18. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 19. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily). 20. calcium acetate 667 mg capsule sig: three (3) capsule po bid (2 times a day): hold for phos<2.5. discharge disposition: extended care facility: discharge diagnosis: basal ganglia hemorrhage with intraventicular extension respiratory failure coma protien/calorie malnutrition ventilator associated pneumonia discharge condition: neurologically stable discharge instructions: general instructions wound care ?????? you or a family member should inspect your wound every day and report any of the following problems to your physician. ?????? keep your incision clean and dry. ?????? do not apply any lotions, ointments or other products to your incision. ?????? do not drive until you are seen at the first follow up appointment. ?????? do not lift objects over 10 pounds until approved by your physician. diet usually no special diet is prescribed after a craniotomy. a normal well balanced diet is recommended for recovery, and you should resume any specially prescribed diet you were eating before your surgery. medications ?????? take all of your medications as ordered. you do not have to take pain medication unless it is needed. it is important that you are able to cough, breathe deeply, and is comfortable enough to walk. ?????? do not use alcohol while taking pain medication. ?????? medications that may be prescribed include: o narcotic pain medication such as dilaudid (hydromorphone). o an over the counter stool softener for constipation (colace or docusate). if you become constipated, try products such as dulcolax, milk of magnesia, first, and then magnesium citrate or fleets enema if needed). often times, pain medication and anesthesia can cause constipation. ?????? you have been discharged on keppra (levetiracetam), you will not require blood work monitoring. ?????? unless directed by your doctor, do not take any anti-inflammatory medicines such as motrin, aspirin, advil, and ibuprofen etc, as this can increase your chances of bleeding. activity the first few weeks after you are discharged you may feel tired or fatigued. this is normal. you should become a little stronger every day. activity is the most important measure you can take to prevent complications and to begin to feel like yourself again. in general: ?????? follow the activity instructions given to you by your doctor and therapist. ?????? increase your activity slowly; do not do too much because you are feeling good. ?????? you may resume sexual activity as your tolerance allows. ?????? if you feel light headed or fatigued after increasing activity, rest, decrease the amount of activity that you do, and begin building your tolerance to activity more slowly. ?????? do not drive until you speak with your physician. ?????? do not lift objects over 10 pounds until approved by your physician. ?????? avoid any activity that causes you to hold your breath and push, for example weight lifting, lifting or moving heavy objects, or straining at stool. ?????? do your breathing exercises every two hours. ?????? use your incentive spirometer 10 times every hour, that you are awake. when to call your surgeon: with any surgery there are risks of complications. although your surgery is over, there is the possibility of some of these complications developing. these complications include: infection, blood clots, or neurological changes. call your physician immediately if you experience: ?????? confusion, fainting, blacking out, extreme fatigue, memory loss, or difficulty speaking. ?????? double, or blurred vision. loss of vision, either partial or total. ?????? hallucinations ?????? numbness, tingling, or weakness in your extremities or face. ?????? stiff neck, and/or a fever of 101.5f or more. ?????? severe sensitivity to light. (photophobia) ?????? severe headache or change in headache. ?????? seizure ?????? problems controlling your bowels or bladder. ?????? productive cough with yellow or green sputum. ?????? swelling, redness, or tenderness in your calf or thigh. call 911 or go to the nearest emergency room if you experience: ?????? sudden difficulty in breathing. ?????? new onset of seizure or change in seizure, or seizure from which you wake up confused. ?????? a seizure that lasts more than 5 minutes. important instructions regarding emergencies and after-hour calls ?????? if you have what you feel is a true emergency at any time, please present immediately to your local emergency room, where a doctor there will evaluate you and contact us if needed. due to the complexity of neurosurgical procedures and treatment of neurosurgical problems, effective advice regarding emergency situations cannot be given over the telephone. ?????? should you have a situation which is not life-threatening, but you feel needs addressing before normal office hours or on the weekend, please present to the local emergency room, where the physician there will evaluate you and contact us if needed. followup instructions: follow-up appointment instructions ??????please call ( to schedule an appointment with dr. , to be seen in 4 weeks. ??????you will need a ct scan of the brain without contrast. ** please call ( to schedule and appointment to be seen by the neurologist within 4 weeks for follow up management of your intracranial hemorrhage. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances injection or infusion of thrombolytic agent percutaneous [endoscopic] gastrostomy [peg] ventricular shunt to abdominal cavity and organs intravascular imaging of intrathoracic vessels arterial catheterization temporary tracheostomy ventricular shunt to extracranial site nec ventricular shunt to extracranial site nec placement of intracerebral catheter(s) via burr hole(s) diagnoses: obstructive hydrocephalus pure hypercholesterolemia unspecified protein-calorie malnutrition hyposmolality and/or hyponatremia intracerebral hemorrhage dysthymic disorder acute respiratory failure alkalosis surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation other encephalopathy malignant essential hypertension ventilator associated pneumonia adult failure to thrive hemiplegia, unspecified, affecting unspecified side coma facial weakness other complications due to nervous system device, implant, and graft acute bronchospasm 

Answer: The patient is high likely exposed to