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: left sided neglect major surgical or invasive procedure: cerebral angiography s/p intra-arterial tpa history of present illness: mr. is a very pleasant 86 year old right handed male with history of hypertension, ? copd, now presenting with left sided neglect. the patient is not fully aware of his deficits, hence he is not able to provide a complete or reliable history. he had been feeling well lately with "chronic trouble breathing." otherwise he was last well apparently last night. this morning a friend called him and home and he was dysarthric. ems was called and he was found on the floor of his home. when asked, the patient reports that he does not have any neurologic deficits. hence neurologic ros is negative. he denies any headache or vision problems. general ros, pt denies f/c/ns, ? chronic sob/doe, no cp, no n/v, no abdominal pain, no diarrhea or constipation, agnosia past medical history: htn copd well controlled on spiriva paroxysmal atrial fibrillation chronic lower leg edema (tinea -feet) obesity inguinal hernia social history: lives alone, no children, no family in the area, he has not designated a hcp, retired auditor, never smoker, denies etoh or illicit drug use. family history: non-contributory physical exam: physical examination: vitals: t: 97.9 p: 79 r: 16 bp: 117/57 sao2: 98% ra general: awake, cooperative, nad. heent: nc/at, no scleral icterus noted, mmm, no lesions noted in oropharynx neck: supple, no jvd or carotid bruits appreciated. no nuchal rigidity pulmonary: lungs cta bilaterally without r/r/w cardiac: rrr, nl. s1s2, no m/r/g noted abdomen: obese soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. extremities: 1+ le brauny edema, venous stasis ulcers bilat. barely palpable dp pulses bilaterally. skin: dry skin on le's. neurologic: mental status: alert, oriented x 3. able to relate history without difficulty. attentive, able to name backward without difficulty. language is fluent with intact repetition and comprehension. there were no paraphasic errors. pt. was able to name both high and low frequency objects, but neglects l side of the page. able to read without difficulty. speech was slightly dysarthric. able to follow both midline and appendicular commands. the pt. had good knowledge of current events. there was no apraxia. he has obvious left sided spatial neglect. cranial nerves: olfaction not tested. perrl 3 to 2mm and brisk. vf with ? l sided field deficit. l umn facial paresis. eomi without nystagmus. normal saccades. facial sensation intact. hearing intact to finger-rub bilaterally. palate elevates symmetrically. 5/5 strength in trapezii and scm bilaterally. tongue protrudes in midline. motor: normal bulk, tone throughout. no adventitious movements noted. no asterixis noted. left parietal drift. 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 5 r 4 5 5 5 5 5 5 5 5 5 5 5 5 5 sensory: diminished sensation to light touch, pp on left arm > leg. coordination: no dysmetria on fnf or hks bilaterally. deep tendon reflexes: tri pat ach l 3 2 2 2 1 r 2 2 2 2 1 plantar response was flexor on right, extensor on left. gait: deferred given prominent neglect. pertinent results: labs: 10:15am blood wbc-7.0 rbc-4.83 hgb-14.8 hct-45.2 mcv-94 mch-30.6 mchc-32.7 rdw-14.7 plt ct-213 09:30am blood wbc-7.1 rbc-4.42* hgb-13.9* hct-41.4 mcv-94 mch-31.3 mchc-33.5 rdw-14.8 plt ct-164 10:15am blood neuts-72.0* lymphs-17.2* monos-6.0 eos-4.2* baso-0.5 10:15am blood pt-13.1 ptt-25.0 inr(pt)-1.1 09:30am blood pt-17.4* ptt-29.2 inr(pt)-1.6* 10:15am blood glucose-111* urean-36* creat-1.1 na-143 k-4.6 cl-109* hco3-24 angap-15 09:30am blood glucose-277* urean-29* creat-1.1 na-144 k-3.7 cl-113* hco3-22 angap-13 10:15am blood ck(cpk)-64 02:33am blood alt-26 ast-30 ck(cpk)-83 alkphos-102 04:01pm blood ck(cpk)-116 10:15am blood ck-mb-notdone ctropnt-<0.01 01:58am blood ck-mb-3 ctropnt-<0.01 02:33am blood ck-mb-notdone ctropnt-<0.01 04:01pm blood ck-mb-3 ctropnt-<0.01 02:33am blood albumin-3.1* calcium-8.1* phos-3.0 mg-2.0 cholest-147 02:33am blood triglyc-68 hdl-44 chol/hd-3.3 ldlcalc-89 01:58am blood %hba1c-5.7 04:40am blood tsh-0.53 10:15am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg imaging: ecg (): atrial fibrillation with controlled ventricular response at a rate of 84. left bundle-branch block with secondary st-t wave abnormalities. no previous tracing available for comparison. cxr (): impression: no acute cardiopulmonary process ct head (): impression: 1. no acute intracranial process seen on nonenhanced ct. please note that mri is more sensitive to evaluate for acute ischemia. 2. hypodensities within the white matter, subcortical, paraventricular, which could be due to chronic small vessel ischemic changes. focus of hypodensity in the left thalamus, which could be due to old ischemic event. 3. mucosal thickening in the maxillary sinuses, more on the right, with possible mucus retention cyst in the right maxillary sinus. 4. lucent areas in the bony calvaria, could be venous lakes, but metastases or multiple myeloma can have similar apperance. cta head/neck and ctp (): impression: 1. abrupt cutoff of the right mca just distal to the m2 branch and branches distal to the m2 are not visualized. there is a perfusion mismatch in distribution of the mca with approximately 30% penumbra identified. no areas of hemorrhage identified on non-contrast images. 2. subtle loss of -white matter differentiation in the right insular ribbon. otherwise no other areas concerning for infarction. 3. remaining intracranial vessels are patent without evidence for aneurysm, stenosis or occlusion. bilateral vertebral and internal carotid arteries are normal. 4. decreased pneumatization seen in bilateral mastoids and questionable mastoidectomy on the left and would recommend clinical correlation. 5. hypodensities in an enlarged left lobe of the thyroid, and would recommend correlation with biochemical markers and thyroid ultrasound if clinically indicated. 6. questionable outpouching at the left pca origin likely a prominent branch as no aneurysm was seen on angiogram performed on same day. cerebral angiography (): impression: mr. is an 86-year-old male who presented with acute left-sided neglect. cta and perfusion showed acute stroke in the right m2 distribution with a 20-30% salvageable penumbra. a total of 6 mg of tpa were infused in divided doses into the right common carotid artery and right internal carotid artery. satisfactory flow was demonstrated after the infusion. ct head (): impression: interval development of hyperdensity in the right insular and temporal cortex, most likely due to luxury perfusion s/p revascularization. cortical microhemorrhage cannot be definitively excluded due to persistent intravascular contrast from the preceding cerebral angiogram, and a repeated study is recommended in 12 hours for reassessment. tte (): the left atrium is normal in size. no thrombus/mass is seen in the body of the left atrium. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. no masses or thrombi are seen in the left ventricle. overall left ventricular systolic function is normal (lvef 55-60%). with normal free wall contractility. no masses or vegetations are seen on the aortic valve. there is no aortic valve stenosis. trace aortic regurgitation is seen. no mass or vegetation is seen on the mitral valve. trivial mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. mr (): impression: right mca infarct along the insular cortex and along the frontal and temporal operculum with petechial hemorrhages. the patient is status post intra-arterial tpa therapy. ct head (): impression: no evidence of acute hemorrhage. interval resolution of apparent luxury perfusion in the right insular and temporal region. brief hospital course: the patient is an 86 year old right handed man with a history of hypertension, transient atrial fibrillation not on coumadin, and copd who presented with left sided neglect. the initial history indicated that the patient had woken up with these symptoms on the day of admission; however, after further history it was determined that symptoms of dysarthria and left sided weakness started at 8:30 am on the day of admission. cta head/neck and ctp showed abrupt cutoff of the right mca just distal to the m2 branch, and branches distal to the m2 were not visualized. there was a perfusion mismatch in the distribution of the mca with approximately 30% penumbra identified. there was also subtle loss of -white matter differentiation in the right insular ribbon. the patient was taken for cerebral angiography, at which a total of 6 mg of ia tpa were infused in divided doses into the right common carotid artery and right internal carotid artery. the patient was intubated for the procedure, and then admitted to the neuroicu. post-angiography head ct showed interval development of hyperdensity in the right insular and temporal cortex, most likely due to luxury perfusion s/p revascularization. the patient was extubated and called out to the neurology floor. mri head showed right mca infarct along the insular cortex and along the frontal and temporal operculum with petechial hemorrhages status post intra-arterial tpa therapy. ekg showed atrial fibrillation. his stroke was thought to be embolic due to atrial fibrillation in the setting of not being anticoagulated. tte showed no thrombus/mass in the left atrium, lvef 55-60%. he was started on an asa 325 mg daily as a bridge to coumadin. he was intially placed on coumadin 5 mg daily but his inr quickly rose from 1.2 to 1.6 in one day, so this was changed to 3 mg daily. his goal inr is , and his aspirin can be discontinued once his inr is therapeutic. his inr was 1.6 at the time of discharge. he was instructed to have his inr drawn on sunday () and tuesday () and phoned in or faxed to dr. (his pcp). his blood pressure was intially allowed to autoregulate in the setting of acute stroke, but his lasix and spironolactone were added back at the time of discharge. his verapamil was held at the time of discharge, and can be added back as needed as an outpatient. flp showed chol 147, ldl 89, hdl 44, tg 68, and he was started on atorvastatin 20 mg daily. hga1c 5.7%. he was instructed to follow up with dr. in neurology as an outpatient. medications on admission: spironolactone 25 mg daily verapamil 180mg daily lasix 20 mg on alternate days albuterol prn sprivia daily discharge medications: 1. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 2. furosemide 20 mg tablet sig: one (1) tablet po every other day (every other day). 3. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 4. spiriva with handihaler inhalation 5. aspirin 325 mg tablet sig: one (1) tablet po daily (daily): to be continued until his inr is therapeutic on coumadin (inr ). disp:*30 tablet(s)* refills:*2* 6. warfarin 1 mg tablet sig: three (3) tablet po once daily at 4 pm. disp:*90 tablet(s)* refills:*2* 7. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. outpatient lab work lab work for pt/inr to be drawn sunday () and tuesday () and phoned in or faxed to dr. (phone , fax ) discharge disposition: home with service facility: vna discharge diagnosis: primary: right mca stroke s/p ia tpa and subsequent petechial hemorrhage paroxysmal atrial fibrillation secondary: hypertension copd discharge condition: oriented to place and date, speech fluent, slightly flattened left nlf, minimal left pronator drift, weak right deltoid but strenght otherwise full, extinguished to dss on left only wihen stimulus is right face/left arm, 3+ pitting edema to knees discharge instructions: you were admitted with left sided neglect, and were found to have a right middle cerebral artery stroke. you were taken to cerebral angiography, and received intra-arterial tpa. mri brain after the procedure showed a small amount of hemorrhage. your heart rhythm was found to be in atrial fibrillation, so you were started on aspirin 325 mg daily as a bridge to coumadin 3 mg daily. your aspirin can be discontinued once your inr is therapeutic (). you should have blood work drawn for inr as an outpatient and followed by dr. . you were started on lipitor 20 mg daily to treat your cholesterol. your blood pressure was allowed to autoregulate in the setting of stroke, so your verapamil was held and this can be added back as needed as an outpatient. if you develop headache, weakness/numbness, difficulty speaking or swallowing, double vision, or any other symptoms that concern you, call your pcp or return to the ed. followup instructions: you should make a follow up appointment with your primary care physician, . () in the next 1 week. you have a follow up appointment with dr. in neurology () on at 2:00 in the center, . procedure: injection or infusion of thrombolytic agent arteriography of cerebral arteries diagnoses: pure hypercholesterolemia unspecified essential hypertension chronic airway obstruction, not elsewhere classified atrial fibrillation cerebral artery occlusion, unspecified with cerebral infarction 

Answer: The patient is high likely exposed to