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: tramadol attending: chief complaint: found down with right upper extremity shaking major surgical or invasive procedure: peg tube placement . history of present illness: the pt is a 35 year-old man with minimal pmh. he was transferred to ed, intubated, from an osh. we were consulted for seizure. by report, he had a trip-and-fall on his head yesterday (sat ), with no loc and no known sequelae. he was reportedly normal that evening and this morning (), and went out with a friend. on returning home in the afternoon he told the friend he felt weak and sat down. when he did not get up hours later, ems was called and they took him to the ed where he was noted to have right-sided arm/leg weakness and expressive aphasia. according to their notes, he was able to give appropriate y/n head-nod/shake responses to questions and follow commands. he denied any h/o stroke, seizure or illicit substance abuse (he was mj/thc+ on their utox screen, however). he was taking nexium for gerd and xanax tid for mood sx (i confirmed these rx with , his pharmacy, and with his hcp/aunt). then, he was noted to exhibit myoclonic jerks of his right arm and leg. a neurology assessment there was partial-complex seizure. he was given a total of 12mg lzp and loaded with 1gm pht to stop the shaking/jerking, and consequently intubated with succ+etomidate for airway protection. he was bolused 200 of propofol, self-extubated, given 2mg/h lzp gtt, 50mcg/h propofol gtt, phenobarbital 65mg iv, and then after re-intubation, was given 4mg more of lzp on transport-ems on the way here due to right-sided shaking. he arrived intubated and sedated on a propofol gtt at 50. he was again re-intubated on arrival (balloon above the vocal cords on arrival). he exhibited shaking of his right arm, and a mdz gtt was started in the ed. a nchct here revealed a left-insular/opercular/subcortical hypodense region (completed infarct), and cta revealed a left ica large occlusion (just proximal to bifurcation) and decreased # of distal mca branches on the left. he has no known risk factors. i spoke on the phone with his hcp/aunt . was apparently in an osh ed 5d pta with cold sx, normal cxr, negative flu swab, sent home. past medical history: -mood/"depression" per osh notes. on bdz -gerd. on omeprazole. -pe in pt 20210g mutation neg () at 3 activity 124 (nml) protein s 131 cardiolipin <6 factor v leiden 3.4 protein c 92 all normal off coumadin (1 month) - drug seeking behavior had stopped coumadin cardiomyopathy - cardiologist ( ) last seen - () nonischemic cmy ed - chest pain pheochromocytoma - resected @ was having stomach pains social history: h/o learning disability (per aunt/hcp), which is why he has a hcp ). special ed, education through 8th grade. cannot read or write well per aunt (small words only). family history: unknown physical exam: admission exam vss in ed (see ed record in chart), afebrile, normotensive (sbp 130s), hr 80s, rr 14 sao2 100% (intubated, on vent/suppl o2) <<exam was greatly limited by sedation not stopped c/f sz.>> general: sedated, intubated. heent: intubated. blood in ett suction catheter after 3x intubations. normocephalic. mild bruise on lt forehead. no scleral icterus. mucous membranes are moist. neck: supple, with full range of motion and no nuchal rigidity. no carotid bruits appreciated, including specifically no bruit over left ica (clot location seen on cta). no lymphadenopathy was appreciated. pulmonary: lungs cta bilaterally. non-labored breathing with vent. cardiac: rrr, normal s1/s2, no m/r/g. abdomen: mildly obese. soft, non-tender, and non-distended, + moderate bowel sounds. no masses or organomegaly were appreciated. extremities: warm and well-perfused, no clubbing, cyanosis, or edema. 2+ radial, dp pulses bilaterally. skin: no rashes or lesions noted. discharge exam eyes open, making eye contact, shakes head yes and no but not appropriately to simple questions, and does not follow axial or appendicular commands reliably or specifically. moves left side spontaneously with apparent full strength. not moving right side, but it withdraws purposefully to noxious stimuli. pertinent results: 08:50pm blood wbc-11.6* rbc-4.38* hgb-13.0* hct-38.0* mcv-87 mch-29.8 mchc-34.3 rdw-13.5 plt ct-285 05:58am blood neuts-67.4 lymphs-24.3 monos-7.5 eos-0.5 baso-0.3 08:50pm blood pt-13.2 ptt-24.2 inr(pt)-1.1 03:57am blood thrombn-43.6* 08:50pm blood fibrino-238 03:57am blood aca igg-2.6 aca igm-4.6 03:57am blood protcfn-101 protsfn-81 05:58am blood glucose-99 urean-8 creat-0.7 na-139 k-4.0 cl-108 hco3-23 angap-12 05:58am blood alt-53* ast-28 ck(cpk)-204 alkphos-50 totbili-0.3 06:43pm blood cholest-288* 05:58am blood %hba1c-6.2* eag-131* 06:43pm blood triglyc-158* hdl-27 chol/hd-10.7 ldlcalc-229* 05:58am blood tsh-0.74 08:50pm urine bnzodzp-neg barbitr-pos opiates-neg cocaine-neg amphetm-neg mthdone-neg marijua-presumptiv micro: sputum cx: staph aureus coag +, pan-sensitive blood cx ngtd ekg: sinus rhythm. left axis deviation may be due to left anterior fascicular block. rsr' pattern with early precordial qrs transition is non-specific. consider posterolateral myocardial infarction of indeterminate age, although is non-diagnostic. st-t wave abnormalities are non-specific but cannot exclude myocardial ischemia. clinical correlation is suggested. no previous tracing available for comparison. imaging: cta head and neck 1. nonocclusive filling defect within the proximal left internal carotid artery, with occlusion of the distal left m1 segment and opercular and insular branches with a nonhemorrhagic infarct in the left mca distribution. the atherosclerotic disease elsewhere is most compatible with a dissection of the proximal cervial with embolization to the left mca. mri brain acute infarct of the left mca territory, likely secondary to dissection as proposed in the prior cta - post-traumatic versus collagen vascular disease etiologies are diagnostic considerations. echocardiogram the left atrium is normal in size. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. eeg this 16-hour recording showed only severe diffuse encephalopathic changes with loss of background and irregular high voltage delta with a little preservation of fast rhythms centrally in the right. this could be anoxic, ischemic, or possibly secondary to medication. no seizure activity or paroxysmal epileptic interictal discharges identified. eeg this eeg shows an evolving encephalopathy going from an extremely severe marked attenuation of all activity which may have reflected drug effect to a still severe encephalopathy with diffuse delta activity and suppression of rhythms posteriorly but there were no ictal or interictal discharges identified. eeg this eeg gives evidence for a severe diffuse encephalopathy that improved minimally during the course of the 24 hours. over the course of 24 hours, however, activity over the left frontal central regions appeared to be more prominent and suggests lateralized difficulty superimposed upon the severe encephalopathy. no clear sustained epileptic activity was identified although an isolated left temporal discharge was seen. eeg this eeg continues to show a severe diffuse encephalopathy that, as the record continued to the end, appeared to be slightly more abnormal broadly across the left hemisphere. note is there is very poorly developed background rhythm in both hemispheres. no epileptic activity was identified. brief hospital course: left middle cerebral artery stroke the patient was admitted after being found down in a hallway with jerking movements of his right arm and an inability to understand commands. he was initially taken to hospital where he was given ativan, dilantin and phenobarb which failed to stop the seizures. he was then transferred to for further care. on arrival he was given keppra, started on versed and propofol drips which aborted the seizure. on imaging he was found to have a large thrombus v. dissection in his left common carotid artery, and mri imaging revealed ischemia of most of the left mca territiory. after careful review of his outside records it was discovered that he had a pulmonary embolism in and had been treated with coumadin until . in a cardiology note it was documented that he was lupus anticoagulant positive. it was unclear why he was taken off anticoagulation. his exam on discharge was notable for being alert, and attentive, globally aphasic and having a right hemiparesis. he was restarted on coumadin in hospital and on lovenox 100 mg subq as bridge therapy until inr is between 2 and 3. methicillin sensitive pneumonia the patient developed a culture positive (s. aureus) pneumonia and was intially treated with vancomycin and zosyn which were switched when sensitivites returned. antibiotics were started on and he should receive a 14-day course (end date ). seizures the patient was loaded with keppra, dilantin, phenobarb as well as versed and propofol to stop his focal right arm seizures. eeg monitoring was performed which showed no epileptiform discharges. his medications were reduced to keppra 1000 mg by time of discharge. no epc noted on discharge form nutrition patient was unable to tolerate po intake and speech and swallow evaluation was performed twice. he received tube feeds, but required peg tube placement on . the procedure was uncomplicated and the patient was given dilaudid for pain. anticoagulation the patient was on a heparin drip after being admitted and was continued until after his peg tube was placed. he was then started on coumadin with a goal inr of 2.0 - 3.0 with lovenox as a bridge until this goal is reached. medications on admission: xanax ?mg tid nexium ?mg daily discharge medications: 1. docusate sodium 50 mg/5 ml liquid sig: po bid (2 times a day). 2. acetaminophen 650 mg suppository sig: one (1) suppository rectal q6h (every 6 hours) as needed for fever or pain. 3. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 4. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. 5. pantoprazole 40 mg recon soln sig: one (1) recon soln intravenous q24h (every 24 hours) as needed for gerd. 6. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush: heparin flush 2ml iv prn line flush picc. flush 10ml normal saline followed by heparin prn per lumen use. 7. levetiracetam 500 mg/5 ml solution sig: two (2) intravenous (2 times a day). 8. nafcillin in d2.4w 2 gram/100 ml piggyback sig: one (1) intravenous q6h (every 6 hours) for 3 days. 9. insulin lispro 100 unit/ml solution sig: per protocol subcutaneous asdir (as directed). 10. levetiracetam 500 mg tablet sig: two (2) tablet po bid (2 times a day). 11. enoxaparin 100 mg/ml syringe sig: one (1) mg subcutaneous q12 hrs (): 90mg sc q12hrs until inr goal of . discharge disposition: extended care facility: rehab unit at - discharge diagnosis: new - left mca stroke - epilepsia partialis continua old - lupus anticogulant positive - hld discharge condition: level of consciousness: alert and interactive. mental status: confused - always. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted for a stroke and seizure. you had a stroke involving the left side of your brain and that led to language deficits. because of this we have started you on coumadin to prevent future strokes. you were also placed on keppra for seizure control. you had a peg tube placed to ensure that you get adequate feedings. followup instructions: dr . of center . at 2pm call to ensure paperwork is in place 3 weeks prior to appointment. please call ( one week prior to appointment to ensure place and time. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] central venous catheter placement with guidance diagnoses: esophageal reflux unspecified protein-calorie malnutrition methicillin susceptible pneumonia due to staphylococcus aureus personal history of venous thrombosis and embolism primary hypercoagulable state aphasia hemiplegia, unspecified, affecting unspecified side cerebral thrombosis with cerebral infarction epilepsia partialis continua, without mention of intractable epilepsy facial weakness dysphagia, unspecified 

Answer: The patient is high likely exposed to