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: erythromycin base / augmentin attending: chief complaint: left sided weakness major surgical or invasive procedure: received iv tpa history of present illness: 64 yo rhm with h/o htn, hl presents with headache, l sided weakness and slurred speech. the patient was golfing on sunday when he suddenly developed a severe headache between his eyes, at onset. the pain was non-throbbing, but caused light sensitivity. he also had blurry vision in the r eye. he thinks he could see fine if he covered the r eye. 10 minutes after the headache, he became "disoriented." he had been golfing with 2 physicians, who called 911. the patient remembers feeling like he could not stand, and was leaning against a golf cart, and could not get in on his own. he remembers being taken by ambulance to hospital. he did not try speaking because he didn't know what was going on, but could hear and understand everything. when he did try speaking it was in the hospital and it was slurred. he initially presented to hospital. bp ws 138/80 and nihss >10, ekg nsr. initial documented exam at 3:15 pm showed gaze prefence to right, l facial droop, l neglect and dense l hemiparesis. he had a negative head ct and received tpa. workup then included carotid u/s which suggested r ica high resistance, and mra showed distal r ica occlusion versus stenosis. mri brain showed r aca and mca territory acute infarct with no hemorrhage. the patient was transferred to for further evaluation and treatment of r ica. during his hospital course, the patient has had constant frontal headache that varies in severity, currently a and associated with photophobia. his speech has been slurred without any worsening or improvement. his r eye vision remained blurred until this morning. on questioning about his l side, he says he has to look at it to move it, but can use his hand to type and can walk. he is also quite insistent that he is not at , but must be on the because of how the ambulance drove here. of note, the patient had a similar acute onset headache 2 weeks ago associated with r eye blurriness, that only lasted 5 minutes. he has never had this type of headache or vision changes before. he has never had migraines. past medical history: htn hl recent foot surgery for bone spur social history: divorced, has stepchildren, lives alone. owns edible arragments franchise. no tobacco, social etoh, no illicits. family history: mother had migraines and mi at age 73, father had clots post-knee surgery. physical exam: vitals: t: afeb p: 65 r: 16 bp: 138/87 sao2: 95/ra general: awake, cooperative, nad. heent: nc/at, no scleral icterus noted, mmm neck: supple. no nuchal rigidity. pulmonary: lungs cta bilaterally without r/r/w cardiac: rrr abdomen: soft, nt/nd extremities: no c/c/e bilaterally skin: no rashes or lesions noted. neurologic: -mental status: alert, oriented x 3 (knows hospital, though does not think he is at ). able to name backwards but with long pauses and requires cues. language is fluent with intact naming, repetition and comprehension. normal prosody. there were no paraphasic errors. able to read without difficulty. speech was mildly dysarthric. able to follow both midline and appendicular commands. pt. was able to register 3 objects and recall at 5 minutes. the pt. had good knowledge of current events. there was no evidence of apraxia of r hand. neglect- patient able to cross midline (grabs left hand with his right hand) and recognize own hand. his head and eyes are turned preferentially to the right but can cross midline. he cannot find the tv in the room (which is on the left). -cranial nerves: perrl 3 to 2mm and brisk. vff to confrontation. eomi without nystagmus. normal saccades. gaze preference and head turned to the r but can cross midline. facial sensation intact to light touch. l lower facial weakness tongue protrudes in midline but slow and clumsy movements. -motor: lle increased tone. r postural tremor. delt bic tri wre ffl fe io ip quad ham ta edb l 0 throughout r 5 5 5 5 5 5 5 5 5 5 5 5 5 5 -sensory: intact light touch and pain, no extinction to dss. -dtrs: tri pat ach l 2 2 2 2+ 2 with clonus r 2 2 2 2 1 plantar response was flexor on r and extensor on l. pertinent results: 09:00pm %hba1c-5.5 eag-111 09:00pm tsh-1.6 09:00pm triglycer-78 hdl chol-59 chol/hdl-3.0 ldl(calc)-101 carotid u/s: r ica high grade downstream stenosis or occlusion mra: short segment of occlusion of distal r ica near skull base. mri: acute infarct r frontal lobe and r bg involving aca and mca distributions. no ich. diminished flow in distal r ica echo: no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. mr head w/o contrast study date of 5:13 pm impression: 1. acute stroke involving the right mca and right aca territories which appears to have progressed since the recent prior cta and mri. 2. short segment dissection in the distal cervical course of the right internal carotid artery. lack of flow-related enhancement in the m2 segment branches of the right mca consistent with occlusion. right shoulder x-ray: four views of the right shoulder, demonstrate moderate acromioclavicular osteoarthritis. moderate glenohumeral osteoarthritis with mild joint space narrowing, osteophytes, subchondral cystic change. in addition, there is amorphous calcification projecting over the supraspinatus tendon, consistent with calcific tendinopathy. visualized right upper lung zone is clear. mri right shoulder: report is pending at the time of discharge. brief hospital course: mr. is a 64 y/o rhm with pmh htn, hld who presented to osh with headache, l sided weakness and slurred speech, for which he received iv tpa. he was found to have r aca/mca stroke and r distal ica occlusion vs stenosis. neuro: he was transferred from hospital after 24 hours post-tpa. neuro exam on presentation was significant for dense l hemiparesis, l neglect and mild dysarthria. he was admitted to the neuro icu. cta showed severe stenosis of the distal right cervical artery with a suggestion of a likely dissection without convincing pseudoaneurysm. mri/a with fat sats was then done and this did confirm diagnosis of dissection. the patient was started on heparin drip bridge to coumadin for anticoagulation. he was discharged on a lovenox bridge. at the time of discharge, the patient continued to have a left visual field neglect. he had flaccid paralysis of the left side, with only 1+/5 movement at the left ip. he was seen by speech and swallow: evaluation on with the following assessment: pt presents with isolated cough during today's evaluation which may be his baseline dry cough/med associated or could have been an isolated episode of aspiration. would recommend continuing with current diet order of regular solids and nectar thick liquids as primary source of po intake. would also continue medications whole with nectar or puree. however, would recommend patient to begin a " free water protocol" in which he's allowed to drink thin liquid h2o between meals after aggressive oral care. pt should be monitored closely for signs of negative sequelae associated with possible intermittent/ occasional aspiration such as worsening respiratory status, increased sob, etc. if these occur, free water protocol should be stopped. we will continue to follow during this admission to ensure diet tolerance and consider further diet upgrades. pt will also benefit from swallow dx/tx in rehab setting upon d/c to continue to upgrade diet as neurological issues resolve. 1. po diet: regular solids, nectar thick liquids 2. po meds whole with puree or nectar 3. free water protocol: a) thin liquid h2o allowed between meals only b) provide aggressive oral care prior to h2o intake 4. assist with meals as needed to maintain standard aspiration precautions and assist with self-feeding. 5. monitor closely for signs of aspiration above and cease water protocol if they occur. 6. continued swallow follow up here and in rehab setting upon d/c for further diet upgrades when medically appropriate. musculoskeletal: the patient noted significant r shoulder pain that was worse with laying flat and significantly limiting his range of motion. a shoulder x-ray was obtained that noted moderate acromioclavicular and glenohumeral osteoarthritis with mild joint space narrowing, osteophytes, and subchondral cystic change. in addition, there is amorphous calcification projecting over the supraspinatus tendon, consistent with calcific tendinopathy. an mri was later obtained due to concern for rotator cuff tear. while the formal read was pending at the time of discharge**** medications on admission: asa 81 mg lisinopril 20 mg lipitor 20 mg discharge medications: 1. ibuprofen 600 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for pain. 2. lovenox 100 mg/ml syringe sig: one (1) subcutaneous twice a day: until inr>2. 3. lisinopril 10 mg tablet sig: one (1) tablet po once a day. 4. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 5. warfarin 7.5 mg tablet sig: one (1) tablet po once daily at 4 pm. 6. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. discharge disposition: extended care facility: - discharge diagnosis: r aca/mca stroke r ica dissection discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. neuro defecits: l neglect (improving), l hemiplegia ( at left ip) vitals on discharge: temp 131/89 hr 57 discharge instructions: you presented to the hospital after acute onset of headache and disorientation with subseque nt slurred speech and left hemiplegia. you received iv tpa and was admitted to the icu at an outside hospital, where a stroke on the right side of your brain was noted. you were transferred to for further management. while here, you had further imaging, which showed that there is a dissection in your right internal cartoid artery. the dissection is beleived to be the source of the clot causing the stroke. you were started on thinning medication called coumadin to help prevent future strokes. while on this medication, you will need to have levels called inr measured. your pcp should monitor these levels after you ar discharged from rehab. followup instructions: department: neurology when: tuesday at 11:30 am with: , md building: campus: east best parking: garage please follow-up with your pcp. : , mark location: family physicians address: , , phone: fax: procedure: injection or infusion of thrombolytic agent diagnoses: unspecified essential hypertension other and unspecified hyperlipidemia dissection of carotid artery dysarthria cerebral artery occlusion, unspecified with cerebral infarction hemiplegia, unspecified, affecting unspecified side 

Answer: The patient is high likely exposed to