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: right sided weakness and language disturbance major surgical or invasive procedure: 1. percutaneous tracheostomy with a bronchoscopy. 2. percutaneous endoscopic gastrostomy. 3. left-sided craniotomy for decompression. 4. hemicraniectomy. 5. temporal lobectomy. 6. duraplasty. history of present illness: 39 year old female with h/o headaches and possible hypertension presents with right arm weakness and inability to communicate. she was last seen normal yesterday at 11:00pm when she went to bed. she usually wakes up at 5:30am in the morning to walk the dog. she usually walks the dog in her pajamas. her husband did not hear her get up this morning and is not sure whether she actually did walk the dog. at 5:41, she shook her husband to awaken him and could not say any words. she was still in her pajamas at that time. she was able to walk with his support, then had a one-minute episode of generalized shaking. she was initially brought to , where she received lorazepam 2mg, phenytoin, and solumedrol 125mg. ct showed an asymmetrical dense left mca sign, and the patient was transferred to for further management. ros: she started a new medication a few weeks ago for headaches. she developed green discharge from the eyes when this medication was started; this has now resolved. 2-3x over the last month she has had a sensation that objects around her were moving. 2x over the last month she has choked on her food. at baseline she has decreased strength in her right hand from her carpal tunnel syndrome. she has been limping for 2 days. she frequently moves around to prevent her headaches. she occasionally has constipation, for which she takes miralax. she has not had any blood in her stool or urine. denies recent problems with fever, vision, hearing, cough, vomiting, weakness, or paresthesias. past medical history: - chronic headaches after being hit on the head by a child in a special education class she was teaching 3-5 years ago. - s/p right carpal tunnel release - s/p hysterectomy 3 years ago - question of hypertension. family denies this and reports sometimes her blood pressure goes low, but the patient is on cardizem and reports sometimes the doctors put on medications without a clearly known reason. - no prior seizures, stroke, intracranial hemorrhage, or recent surgeries social history: works as a special education teacher. husband, daughter, and sister at bedside. denies etoh, smoking, illicits. family history: sister had a stroke at age 33; she does not know the cause of this. sister has also had a dvt and headaches. dad had a stroke at age 62. physical exam: initial t 98.6, hr 98, bp 130/80, rr 16, o2sat 98% 4l gen: lying in bed, nad heent: normocephalic, atraumatic. mucous membranes moist. neck: supple back: no point tenderness or erythema cv: rrr, nl s1 and s2, no murmurs/gallops/rubs lung: clear to auscultation bilaterally abd: +bs soft, nontender skin: no rash ext: no edema neurologic examination: mental status: general: stuporous. with sternal rub arouses for less than a minute, then closes eyes again. speech/language: moans with some unintelligible sounds that may be attempts at words. does not follow simple commands. . cranial nerves: ii: pupils equally round and reactive to light, 4 to 2 mm bilaterally. ignores $20 in right visual field. iii, iv, vi: near complete eye movement to the right but does not bury sclera. extraocular movements otherwise intact without nystagmus. v1-3: patient unable to state whether facial sensation is intact. vii: right lower facial droop with showing the teeth. viii: hearing grossly intact; turns to voice. ix & x: not tested. : not tested. xii: not tested. . motor: normal bulk bilaterally. tone normal. no observed myoclonus or tremor. able to bend right arm antigravity at elbow but cannot lift upper arm off bed. when the arm is held up, it falls back to the bed. able to hold left arm, right leg, and left leg antigravity for 10 seconds. . deep tendon reflexes: biceps: tric: brachial: patellar: achilles toes: right 2 2 2 3 2 downgoing left 2 2 2 3 2 downgoing positive crossed adductors. . sensation: withdraws to noxious in all extremities. . coordination: finger-nose-finger normal on the left. . gait: not tested. discharge exam t 97.4 p 88 bp 113/66 r 18 spo2 100% gen: lying in bed, alert but not verbal pertinent results: ct perfusion: 1. thrombus within the distal left m1 segment with poor filling of left anterior temporal branches. the focal moderate stenosis of the left internal carotid artery origin, with no other evidence of vascular atherosclerosis, may represent a dissection or intramural hematoma and may be a source of this thrombus. 2. ct perfusion reveals a very small region of relatively preserved cbv and cbf with in the most posterior/superior region of the prolonged mtt which may represent a small area of ischemic penumbra. however, the vast majority of the prolonged mtt is matched. cta 1. thrombus within the distal left m1 segment with poor filling of left anterior temporal branches. the focal moderate stenosis of the left internal carotid artery origin, with no other evidence of vascular atherosclerosis, may represent a dissection or intramural hematoma and may be a source of this thrombus. 2. ct perfusion reveals a very small region of relatively preserved cbv and cbf with in the most posterior/superior region of the prolonged mtt which may represent a small area of ischemic penumbra. however, the vast majority of the prolonged mtt is matched. mr 1. interval expected evolution of the patient's large left mca territory infarct, which spares the vast majority of the basal ganglia and thalamus. the anterior and posterior portions of the infarct extend medially into the aca territories. this could be secondary to interval emboli to these regions with/without a component of watershed ischemia. 2. faint regions of susceptibility artifact within the infarct concerning for early/petechial hemorrhage. follow up with non-contrast ct head. tte impression: mild pulmonary artery systolic hypertension. normal biventricular cavity sizes with preserved global and regional biventricular systolic function. no definite cardiac source of embolism identified. if clinically indicated, a tee would be better able to define a potential atrial septal defect/patent foramen ovale. cxr findings: as compared to the previous radiograph, the extent of air in the abdomen has minimally decreased. also decreased is the pre-existing relatively extensive right pleural effusion. improved ventilation of the left lung base. normal size of the cardiac silhouette. no newly appeared focal parenchymal opacities. post-surgical ct findings: the patient is status post left frontotemporal craniectomy. there has been interval resolution of post-operative pneumocephalus. a large left parenchymal hypodensity in the middle and anterior cerebral artery distribution is unchanged compared to most recent studies. foci of hyperdensity within this region likely representing foci of hemorrhagic conversion are also unchanged compared to prior. there has been interval improvement in the rightward shift of normally-midline structures, with improvement in effacement of the left lateral ventricle and the basilar cisterns. there is no evidence of new hemorrhage or infarct. brief hospital course: 39 yr hispanic female right handed presents with sudden onset of global aphasia and right side weakness and possible seizure. patient was intially treated at osh with ativan and solumedrol. patient had ct of head that showed a hyperdense left mca concerning for an occlusion of the left mca. there were no early signs of ischemia on that ct brain. the patient was transferred to . nihss at ed was initially 15 and then decreased to 12. cta brain showed a left mca distal m1 occlusion. cta neck was concerning for a left proximal ica dissection. ct perfusion showed a small area of mismatch in the superior division of the left mca. neuro: being out of the window for iv tpa, patient was taken to angio suite and underwent a thrombectomy with the merci device. after multiple passes with the merci clot retriever, the left superior division of the mca was partially opened up. vasospasm of the left superior division was noted, which seemed to respond to nitroglycerin. during the angio it was confirmed that patient had a left carotid dissection. patient was admitted to the neuroicu w. q1hr neuro checks. follow up head ct has demonstrated increased edema with 8 mm of midline shift but no bleed. since there was no intracranial hemorrhage, on patient was restarted on aspirin. however given her increased edema and potential increase in icp, neurosurgery was consulted. patient was placed on iv mannitol. later on a central line was placed. at 4:20pm on patient's pupils became dilated and fixed at 6 mm, with minimal gag, minimal oculocephalic and minimal corneals. patient was given 3% hypertonic saline and hyperventilated. ct demonstrated increase in shift to the right. patient was given 30 ml of 23.4% ns. extensive discussion was held with family (including her husband and two daughters) about goals of care and poor prognosis. the family requested that left hemicraniectomy be performed to save her life. they understood that left hemicraniectomy would not improve her function or reverse her deficits. patient underwent left hemicraniectomy and partial left temporal lobectomy. for the carotid dissection a follow up carotid u/s was done which demonstrated l ica < 40% stenosis; r ica 0% stenosis. stroke was thought to be secondary to thrombus that embolized from the dissection. for secondary protection, simvastatin 40 mg was started for an ldl of 161. a1c was 5.5. tsh was 0.60. patient also had noted generalized shaking while at lgh. she was loaded with phenytoin. a routine eeg was performed which demonstrated encephalopathy. no subsequent sz activity was noted during her hospitalization. phenytoin levels remained stable. patient was maintained on fosphenytoin 100mg iv q8h for seizure prophylaxis and was kept on seizure, fall, and aspiration precautions. cardiovascular: - patient initially kept at sbp goal 140-180 (must keep sbp<185 dbp<105. her bp goal was eventually lowered. transthoracic echo demonstrated an lvef >55%;mild pulmonary artery systolic hypertension, but no source of emboli. pulmonary: - intubated prior to ir procedure gastrointestinal / abdomen / nutrition: - difficulty with ng tube placement. resume feeds per post op care. renal: - patient's i's and o's were monitored with foley. endocrine: - patient was kept on an riss, goal fs<150 infectious disease: - patient has continued to trend upward on wbc count. low grade fever at point of herniation going into or. finished 10-day course of zosyn. afebrile >72 hours, no leukocytosis. id fellow signed off. prophylaxis: dvt: boots, famotidine communication: (, ( code status: full medications on admission: cardizem cd 120mg po daily amitriptyline 10mg po qhs gabapentin 300mg po bid ibuprofen 800mg po tid prn pain excedrin migraine 250-250-65mg q4-6h prn headache miralax prn constipation discharge medications: 1. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 3. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 4. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 5. white petrolatum-mineral oil 56.8-42.5 % ointment sig: one (1) appl ophthalmic prn (as needed) as needed for dry eyes. 6. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic prn (as needed) as needed for dry eyes. 7. lactulose 10 gram/15 ml syrup sig: fifteen (15) ml po q8h (every 8 hours) as needed for constipation. 8. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 9. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for constipation. 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) treatment inhalation q6h (every 6 hours) as needed for wheezing. 11. levetiracetam 250 mg tablet sig: three (3) tablet po bid (2 times a day). 12. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). discharge disposition: extended care facility: for the aged - macu discharge diagnosis: left sided mca stroke left ica dissection gram - rods pneumonia discharge condition: activity status: bedbound. alert but non-verbal discharge instructions: you were admitted to the neurology service at after you had onset of right-sided weakness and difficulty speaking. we attempted interventional thrombectomy and it was discovered there was an ica dissection. after the procedure you developed swelling and required a temporal lobectomy and hemicraniotomy by neurosurgery. you did not regain speech, and were unable to follow commands on discharge. you will be sent to rehab and will follow-up with neurosurgery and neurology. medications started 1. aspirin 325 mg daily 2. simvistatin 3. senna/colace 4. famotidine 5. keppra 750 mg 6. bisacodyl, lactulose 7. metoprolol 25 mg po tid followup instructions: the patient will need to follow up with at in weeks. a follow-up appointment will be arranged. the patient will need followup with neurosurgery in weeks. an appointment will be arranged. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances arteriography of femoral and other lower extremity arteries percutaneous [endoscopic] gastrostomy [peg] arteriography of cerebral arteries temporary tracheostomy other repair of cerebral meninges operations on two or more extraocular muscles involving temporary detachment from globe, one or both eyes lobectomy of brain other craniectomy incision of vessel, intracranial vessels diagnoses: pneumonia due to other gram-negative bacteria unspecified essential hypertension other convulsions occlusion and stenosis of carotid artery without mention of cerebral infarction compression of brain acute respiratory failure dissection of carotid artery other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation cerebral edema headache other specified complications of procedures not elsewhere classified cerebral embolism with cerebral infarction encephalopathy, unspecified aphasia other alteration of consciousness other conditions of brain late effects of other accidents facial weakness other musculoskeletal symptoms referable to limbs family history of stroke (cerebrovascular) homonymous bilateral field defects late effect of injury to blood vessel of head, neck, and extremities 

Answer: The patient is high likely exposed to