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: no known allergies / adverse drug reactions attending: chief complaint: unsteady gait, slurred speech, headache, fall from bed major surgical or invasive procedure: peg placement history of present illness: 77 yo w h/o dm2, htn, hyperthyroidism admitted and p/w unsteady gait, slurred speech and ha on , fall out of bed on which prompted hospitalization, and further decompensation on with nonresponsiveness, likely due to r proximal mca occlusion causing completed r entire mca infarction past medical history: diabetes mellitus type 2 hypertension hyperthyroidism colonic polyps s/p appendectomy s/p bilateral cataract surgeries social history: divorced, has two children. no tobacco or etoh. family history: not known physical exam: at admission: general: asleep, nad, lying in bed comfortably. head: nc/at, no scleral icterus, no oropharyngeal lesions neck: supple, no nuchal rigidity cardiovascular: rrr, soft aortic murmur radiating to the carotids bilaterally pulmonary: equal air entry bilateraly, no crackles or wheezes abdomen: soft, nt, nd, +bs, no guarding extremities: warm, no edema, palpable radial/dorsalis pedis pulses neurologic examination: - mental status - easily awakened, alert, oriented x 3. attention attainable and maintainable through interview. follows commands, midline and appendicular. language fluent with intact verbal comprehension. + mild dysarthria. - cranial nerves - perrl 2-1.5 brisk. eyes do not cross midline to left. l nlf flattening. palate elevation symmetric. tongue midline. - motor - normal bulk and tone. no pronation, no drift. no tremor or asterixis. = ] l 1 1 1 x x 2 2 2 x x x r 5 5 5 5 5 5 5 5 5 5 5 - sensory - withdraws to pain in four extremities. - reflexes - plantar response extensor bilaterally - coordination - no dysmetria with mirrored movements on r arm. at discharge: vitals: t 97 bp 150-170/38-60s hr 70s rr 16 o2 sat: 92-93% on 2-3l nc o2 general: nad, lying in bed comfortably. head: nc/at, no scleral icterus, no oropharyngeal lesions neck: supple, no nuchal rigidity cardiovascular: rrr, soft aortic murmur radiating to the carotids bilaterally pulmonary: equal air entry bilaterally, no crackles or wheezes abdomen: soft, nt, nd, +bs, no guarding extremities: warm, no edema, palpable radial/dorsalis pedis pulses neuro: easily arousable, oriented x 3, eye-opening apraxia, eyes cross midline, left homonymous hemianopia, l nlf flattening, rue/rle full strength, languge fluent wit intact repetition and comprehension. no movement in lue or lle. perceives light touch stimuli on both left and right as "right". recognizes left hand as own. pertinent results: 09:20pm wbc-11.2* rbc-3.57* hgb-10.6* hct-30.5* mcv-86 mch-29.7 mchc-34.7 rdw-14.5 09:20pm pt-12.4 ptt-26.9 inr(pt)-1.0 09:20pm calcium-9.2 phosphate-3.3 magnesium-2.2 09:20pm ck-mb-3 ctropnt-0.03* 09:20pm glucose-152* urea n-26* creat-1.2* sodium-134 potassium-4.2 chloride-104 total co2-21* anion gap-13 nhcht negative, old l basal ganglia lacune mri/mra brain and mra neck - ?small right parietal infarct, ?r proximal mca narrowing mri brain - r entire mca territory infarction ekg: sinus rhythm. normal tracing. no previous tracing available for comparison. : routine eeg: impression: abnormal eeg due to mild posterior background slowing for age suggestive of a mild diffuse encephalopathy with superimposed right posterior quadrant relative paucity of faster activities consistent with the clinical history of a right mca stroke and to bursting slowing occurring in a bifrontally predominant but generalized distribution with some degree of semi-rhythmic and semi-rhythmic and sharp activity seen bifrontally. the record overall is consistent with a vascular etiology with the clearly defined right mca but with the possibility of a second vascular process involving subcortical or deeper midline structures with some degree of increased irritability. nchct impression: 1. large right middle cerebral artery distribution infarct involving the frontal, temporal, occipital lobes as well as the caudate and putamen. there is associated mild effacement of the right lateral ventricle, without shift of the normally midline structures. carotid us impression: right ica 60-69% stenosis. left ica bo-69% stenosis. cxr findings: cardiac silhouette is mildly enlarged and accompanied by pulmonary vascular congestion. minimal patchy opacities at both bases probably reflect atelectasis, but aspiration is additional consideration considering clinical suspicion for this entity. / ltm eeg: prelim read: right hemisphere slowing and right t4 spikes intermittently, no apparent epileptiform activity. ekg: atrial fibrillation with rapid ventricular response. delayed r wave transition. poor baseline. compared to the previous tracing of atrial fibrillation is new. rate 128 brief hospital course: the patient is a 77 year old woman with a h/o dm2, htn, and hyperthyroidism admitted to hospital on with complaints of unsteady gait, slurred speech and headache that started during the day on and are likely the result of an acute ischemic stroke. on the morning of , she fell out of her bed upon waking which prompted her hospitalization. she had no neurologic deficits documented on her admission exam. her ct imaging was unremarkable and her mri showed the suggestion of a small right parietal infarct. she was treated with a full dose aspirin. the following day, she developed slurred speech, left sided face and arm weakness and was later found by the bedside unresponsive. she was reimaged and was found to have an extension of her initial infarct to cover the entire right mca territory. she was transferred to for further care as well as concern for potential seizure activity and midline shift. her exam had changed to include eye opening apraxia, left lower face weakness, left upper extremity paraplegia, and left lower extremity weakness with otherwise preserved mental status, right sided motor function, and sensation. on route she received mannitol x 1 for concern of midline shift. neuro: right mca ischemic infarct: the patient's exam and repeat imaging at on showed stable infarct without midline shift. - the patient was transferred on levetiracetam 250 for seizure prophylaxis although eeg negative. this was discontinued as repeat routine eeg and then long term monitoring also proved negative. - carotid us was done that showed right ica 60-69% stenosis, eft ica bo-69% stenosis, and it was hypothesized that artery-artery thromboembolus may have been the etiology of the infarct. - during this admission, despite no previous history of atrial fibrillation, the patient went into a-fib with rvr overnight. likely the patient has intermittent a-fib and was not on anticoagulation, so this is also a possible etiology. she was started on coumadin for anticogaulation on . cards: htn and new diagnosis of intermittent atrial fibrillation - the patient was hypertensive intermittently during her stay. she is currently sbp 150-170s on amlodipine 10mg po daily, enalapril 20mg po bid, metoprolol 37.5mg po tid, and hctz 25mg po daily. - intermittent atrial fibrillation was seen on telemetry with one episode of rvr that resolved with metoprolol. currently the patient is in normal sinus rhythm. coumadin was started on . gi: impaired swallow ability on evaluation. - peg placed while patient under goes rehabilitation. pulm: patient received ivf and became volume overloaded per exam and chest xray that showed bilateral pleural effusions. she responded well to 1-2 doses of iv furosemide. - currently the patient is requiring liter nasal cannula o2 to maintain 93-94% saturation. endo: patient has type 2 diabetes. - the patient's blood sugar was monitored 4 times daily and maintained on a regular insulin sliding scale. - hgba1c 6.8 renal: no issues. patient is at baseline, normal renal function. medications on admission: asa 325 mg amiodarone 150 mg iv daily enalapril 1.25 mg iv q8h lovenox 72.5 mg sc daily hydralazine 10 mg q6 keppra 250 mg q12 metoprolol tartrate 50 mg po daily protonix discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po hs (at bedtime). 2. enalapril maleate 10 mg tablet sig: two (2) tablet po bid (2 times a day). 3. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 4. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. 5. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po tid (3 times a day). 6. hydrochlorothiazide 12.5 mg capsule sig: one (1) capsule po daily (daily). 7. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 8. baclofen 10 mg tablet sig: one (1) tablet po tid (3 times a day). 9. ibuprofen 100 mg/5 ml suspension sig: four hundred (400) mg po q8h (every 8 hours) as needed for muscle pain. 10. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 11. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed for wheezing/sob. 12. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 13. aspirin 325 mg tablet sig: one (1) tablet po daily (daily): please stop when inr is therapeutic (goal ) on coumadin. 14. insulin regular human 100 unit/ml solution sig: five (5) units injection asdir (as directed): please use insulin sliding scale for blood sugar > 150. 15. glucagon (human recombinant) 1 mg recon soln sig: one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 16. dextrose 50% 12.5 gm iv prn hypoglycemia protocol discharge disposition: extended care facility: discharge diagnosis: r mca ischemic infarct intermittent atrial fibrillation hyperlipidemia discharge condition: mental status: confused - sometimes. level of consciousness: lethargic but arousable. activity status: out of bed with assistance to chair or wheelchair. neuro: drowsy but easily arousable, oriented x 3, eye-opening apraxia, left homonymous hemianopia, eyes cross midline to left, mild-moderate dysarthia, l nlf flattening, rue/rle full strength, no movement of left side, sensation to pain and light touch intact, dss extinction on left. discharge instructions: you were admitted to the hospital for a stroke. this stroke could have been caused due to carotid artery disease and or from a clot from your heart, given you were found to intermittently have a heart arrhythmia, atrial fibrillation. we have started you on a cholesterol-lowering medicine, simvastatin to help decrease your risk of artery disease and subsequent brain or heart events in the future. also, given the intermittent atrial fibrillation, we recommend that you stay on a blood thinner, warfarin (aka coumadin). this medicine requires frequent blood work monitoring and will increase your risk of bleeding from falls but it will decrease your risk of stroke in the future. followup instructions: please follow up with dr. in clinic on tuesday, at 1pm. , building, . provider: , md, phd:. please call if you need to reschedule. md, procedure: enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] diagnoses: unspecified pleural effusion unspecified essential hypertension unspecified protein-calorie malnutrition atrial fibrillation thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm other and unspecified hyperlipidemia diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled cerebral embolism with cerebral infarction dysarthria hemiplegia, unspecified, affecting unspecified side other fluid overload homonymous bilateral field defects dysphagia, unspecified neurologic neglect syndrome 

Answer: The patient is high likely exposed to