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 drug allergy information on file attending: chief complaint: sudden onset left sided weakness major surgical or invasive procedure: iv tpa at outside hospital history of present illness: hpi: 55 yo rhm who was in bed felt dizzy around midnight, he did not have a headache or neck pain. he then could not move his left leg, and within a few seconds, he could not move his left arm. he felt that his arm was stronger than his leg. he was taken to and he had a ct head scan which was unremarkable. he was not given iv tpa since he was on coumadin, despite an inr of 1.3, and sent to . since he was still within the 3 h window for ivtpa the stroke fellow dr . was contact immediately. . ros: apart from left sided weakness, he has a baseline of palpitations, but he had no other cardiac or respiratory or gu or gi symptoms. past medical history: disease s/p radioiodine ~ y ago, subsequent atrial fibrillation gout achilles tendon surgery in ' social history: ex-smoker, occasional alcohol works as a doctor married: () pcp: , , hosp () work partner & friend: , fiance () family history: mother had an mi aged 69 physical exam: t-97.4 bp-108/56 hr-100 rr-20 o2sat-98% on 2l oxygen gen: lying in bed, nad heent: nc/at, moist oral mucosa, proptosis b/l neck: no tenderness to palpation, normal rom, supple, no carotid or vertebral bruit 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 ext: no edema . neurologic examination: nihss: 1a. level of consciousness: 0 1b. loc questions: 0 1c. loc commands: 0 2. best gaze: 0 3. visual: 0 4. facial palsy: 0 5a. motor arm, left: 4 5b. motor arm, right: 0 6a. motor leg, left: 4 6b. motor leg, right: 0 7. limb ataxia: 0 8. sensory: 0 9. best language: 0 10. dysarthria: 0 11. extinction and inattention: 1 . nihss = 9 . mental status: awake and alert, cooperative with exam, normal affect. oriented to person, place, and date. attentive, says backwards. speech is fluent with normal comprehension and repetition; naming intact. no dysarthria. and writing intact. registers , recalls in 5 minutes. no right left confusion. no evidence of apraxia or neglect. . cranial nerves: pupils equally round and reactive to light, 3 to 2 mm bilaterally. fundoscopy normal. visual fields are full to confrontation. extraocular movements intact bilaterally, no nystagmus. sensation intact v1-v3. facial movement symmetric. hearing intact to finger rub bilaterally. palate elevation symmetrical. sternocleidomastoid and trapezius normal bilaterally. tongue midline, movements intact . motor: normal bulk bilaterally. tone normal. no observed myoclonus or tremor no pronator drift tri wf we fe ff ip h q df pf te tf r 5 5 5 5 5 5 5 5 5 5 5 5 5 5 (can wriggle left thumb slightly) sensation: intact to light touch, pinprick, vibration and proprioception throughout. extinction to dss on the l leg . reflexes: +2 and symmetric throughout. toes: downgoing on the r, mute on the l . coordination: finger-nose-finger normal on the r, heel to shin normal on the r, rams normal on the r. . gait: not assessed, dense l hemiparesis pertinent results: admission labs: 02:15am glucose-112* urea n-17 creat-1.3* sodium-138 potassium-4.0 chloride-103 total co2-20* anion gap-19 02:15am ck(cpk)-244* ctropnt-<0.01 ck-mb-5 02:15am cholest-260* triglycer-201* hdl chol-50 ldl(calc)-170* 02:15am wbc-17.4* rbc-4.66 hgb-15.1 hct-43.5 mcv-94 mch-32.5* mchc-34.7 rdw-14.0 02:15am neuts-89.6* lymphs-7.8* monos-2.0 eos-0.5 basos-0.1 02:15am plt count-194 02:15am pt-17.3* ptt-26.1 inr(pt)-1.6* . cta head and neck: ct of the head: no edema, mass, mass effect, hemorrhage or infarction is detected. the ventricles and sulci are mildly prominent consistent with involutional changes. periventricular white matter hypodensities are noted. the visualized part of the paranasal sinuses and mastoid air cells are clear. . cta of the head and the neck: the vertebral and carotid arteries and their branches are patent with no significant mural irregularity or flow-limiting stenosis. no aneurysm is detected. incidental note is made of fenestration at the origin and proximal portion of the a2 segment of the right aca, as well as fetal pcas, bilaterally. the distal cervical portion of the right carotid artery measures 6.2 mm on the right, and 5.6 mm on the left. . ct perfusion: no abnormality of cerebral blood flow, blood volume or the mean transit time within the middle cerebral artery vascular territory. . impression: 1. no acute intracranial process, including no hemorrhage and no evidence of acute infarction (perfusion assessment largely limited to the mca territory). 2. normal cta of the head and neck. . mri/a head: findings: abnormal slow diffusion consistent with acute infarct is seen in the right parasagittal frontal lobe, in the distal right mca distribution. additionally, there is apparent bilateral cortical parietal parasagittal swelling, without corresponding abnormal diffusion signal (series 12, image 20). there is no acute hemorrhage, shift of midline structures, or hydrocephalus. normal flow voids are identified. . mra demonstrates patent, normal-appearing a2 segments bilaterally. the left a1 segment appears attenuated compared to the right. this has changed from its normal appearance on cta performed earlier the same day. large bilateral pcoms also identified. limited imaging of the basilar artery is performed. . impression: 1. findings consistent with infarct in the distal right aca territory, not visualized on prior ct perfusion study. a2 segments appear widely patent bilaterally. 2. relative attenuation of the left a1 segment compared to right, possibly representing embolus or spasm. this finding is new compared to prior cta performed earlier the same day. 3. bilateral parasagittal cortical swelling the parietal lobe, without corresponding diffusion abnormality. this possibly represents a reperfusion injury. . tte: the left atrium is moderately dilated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. there was few bubbles late ( heart beats) with cough manuever. the right atrial pressure is indeterminate. there is mild symmetric left ventricular hypertrophy with normal cavity size. regional left ventricular wall motion is normal. overall left ventricular systolic function is low normal (lvef 50-55%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic arch is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. . impression: mild symmetric left ventricular hypertrophy with low normal systolic function. no definitive pfo identified. brief hospital course: patient is a 55 yo rhm who presented with an acute onset left hemiparesis (leg > arm, no facial weakness, and slightly slower production of speech, but no aphasia). given his history of a fib it was felt to most likely be a cardioembolic stroke, and he was subtherapeutic on his coumadin on presentation (inr 1.3 at osh prior to tpa). he received iv tpa at 3 am and was admitted to icu initially where he remained stable with improving l sided weakness and no hemorrhagic transformation confirmed with repeat ct the next day. . mri showed l aca distribution stroke likely embolic in nature given afib and subtherapeutic inr. echo was performed no obvious thrombus with lvef 50~55% and no pfo/asd. coumadin was restarted on with lovenox bridging. lovenox should be stopped when inr is therapeutic from 2.0-3.0. patient's inr was 1.6 on the day of discharge to rehab facility. . patient was also started on simvastatin 40mg for ldl of 170. the patient expressed interest in following up with dr. regarding the possibility of a surigcal procedure for ablation of a fib, so this was arranged. . his strength steadily improved over his hospital stay, and on the day of discharge he was able to lift both his arm and his leg off the bed, and had 4+/5 strength in an umn pattern in his arm and 4/5 strength in an umn pattern in his leg. medications on admission: atenolol coumadin has not checked inr for several months, due to work allopurinol discharge medications: 1. allopurinol 300 mg tablet sig: one (1) tablet po daily (daily). 2. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 3. enoxaparin 80 mg/0.8 ml syringe sig: one (1) subcutaneous q12h (every 12 hours): discontinue once inr >2.0. 4. atenolol 25 mg tablet sig: one (1) tablet po daily (daily). 5. warfarin 5 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)): need to titrate the dose based on inr - please foward the inr results which needs to be drawn daily initially. 6. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 7. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 8. outpatient lab work daily inr until inr between 2~3 and stable - may need to adjust coumadin dosing based on inr. once inr stable and coumadin dosing fixed, may need to space out the lab checks. please foward the results to pcp, . , l discharge disposition: extended care facility: - discharge diagnosis: r aca cerebral infarct likely embolic atrial fibrillation discharge condition: stable - l leg weakness more than arm but no issues with speech or swallowing. currently being bridged with asa 81mg once daily and lovenox 90 twice daily while inr subtherapeutic. inr 1.6 on the day of discharge. discharge instructions: you were admitted after acute l sided weakness after iv tpa in the ed with hx of atrial fibrillation but subtherapeutic inr. you were initially admitted to the icu where you were monitored and treated including follow-up ct of head which did not show hemorrhagic transformation. you remained stable with improving l sided weakness hence you were transferred to the floor on and you were restarted on coumadin with lovenox bridging. your inr is 1.6 on the morning of discharge to acute rehab facility. you will be continued on lovenox on inr is therapeutic (inr 2~3). please take meds as scheduled and you have scheduled appointments with dr. (neurology) and dr. (cardiology). please call your pcp or go to the nearest ed if you have new/worsening weakness or numbness, speech issues or vision problems. you are being discharged to acute rehab facility where you will receive inpatient physical and occupational therapy plus coumadin titration for your atrial fibrillation. followup instructions: provider: , m.d. phone: date/time: 3:20 provider: , md, phd: date/time: 2:00 please follow up with you pcp, . within 2~3 weeks of discharge including follow-up of inr and coumadin dosing. md, procedure: injection or infusion of thrombolytic agent diagnoses: gout, unspecified atrial fibrillation long-term (current) use of anticoagulants cerebral embolism with cerebral infarction muscle weakness (generalized) iodine hypothyroidism status post administration of tpa (rtpa) in a different facility within the last 24 hours prior to admission to current facility 

Answer: The patient is high likely exposed to