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: off balance, vomiting major surgical or invasive procedure: arterial line placement history of present illness: pt. is a 68 year old with a history of aortic dissection s/p arch repair and fem-fem bypass, started on coumadin for clot in the bypass, who presents with nausea/vomiting, and feeling off balance since friday (3 days pta), found to have a cerebellar hemorrhage on osh head ct. pt. reports that he woke up early friday morning in a sweat. he tried to get out of bed and he felt like he was "tilting" to the left. he had no balance on his feet, and had to hold onto things to keep from falling. he did not have any room spinning feeling. he had a headache in the morning that was bifrontal and achy, which resolved by the afternoon. he spent the day in bed because he felt too unsteady to leave. he threw up once in the morning, and felt somewhat nauseated for the rest of the day. the next day he still felt that his balance was off, and that he had to hold onto the walls to walk, but he was able to get out of bed. he still felt like he was falling to the left. sunday he felt about the same. today he felt his balance was if anything somewhat worse, and he threw up after breakfast, so he decided to present to the hospital. on ros he denies (and his family concurs) any facial droop, diplopia, blurry vision, dysarthria, word finding or comprehension problems, dysphagia, weakness, numbness, tingling, headache, or bowel or bladder incontinence. at osh head ct was performed and showed an 18 mm midline cerebellar hemorrhage. inr was checked and was 3.97, and he was given vitamin k 10 mg po x 1. his bps were 130s-140s there. on their exam he had a surgical non-reactive pupil on the l, reactive on the r, intact strength and sensation, intact fnf bilaterally, and moderate to severe gait ataxia. he was transferred here. here he received profiline x 2 vials at 14:30. he was evaluated by neurosurgery, who felt he required no acute neurosurgical intervention. past medical history: - aortic dissection with aortic hemiarch repair, aortic root repair, femoral to femoral bypass, and rle fasciotomy for compartment syndrome - multiple bilateral strokes (right parietal and bilateral frontal) thought to be embolic from aortic arch repair, initially with some residual l facial droop and l hand weakness, now resolved per family and pt. - left ear surgery for decreased hearing - l vitreous hemorrhage, l retinal detachment s/p surgical repair social history: pt is a retired machinist. lives with his wife. former , quit. 3 drinks/day for years. family history: no history of stroke. father with chf physical exam: t- 97.6 bp- 166/75 hr- 63 rr- 14 o2sat- 99% on 2l gen: lying in bed, nad heent: nc/at, moist oral mucosa 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: mental status: awake and alert, cooperative with exam, normal affect. oriented to person, place, and date. attentive. speech is fluent with normal comprehension and repetition; naming intact. no dysarthria. registers , recalls in 5 minutes. no right left confusion. no evidence of apraxia or neglect. cranial nerves: pupil surgical, irregular, nr on l, 4 -2 on r. 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 l 5 5 5 5 5 5 5 5 5 5 5 5 5 5 sensation: intact to light touch, pinprick, vibration and proprioception throughout. no extinction to dss reflexes: +2 and symmetric throughout. toes downgoing bilaterally coordination: finger-nose-finger normal, heel to shin normal, rams clumsy bilaterally, l > r. gait: wide based, very unsteady, sways l and backwards intermittently romberg: sways backwards, stumbles back discharge exam: unchanged as above with continued gait ataxia. pertinent results: cta head w&w/o c & recons 9:20 pm non-contrast head ct: again demonstrated is a round area of increased attenuation consistent with hemorrhage which appears to displace the fourth ventricle to the right and therefore could be located within the cerebellar vermis. the area of hemorrhage measures 1.6 x 1.7 cm which is stable to both prior comparison ct's. no hydrocephalus is seen. again demonstrated is almost complete effacement of the fourth ventricle. no other new areas of intracranial hemorrhage are identified. re-demonstrated are stable foci of hypoattenuation in the frontal lobes bilaterally and in the right parietal lobe consistent with chronic lacunar infarcts. mild mucosal thickening is seen in the right maxillary sinus and ethmoid air cells. the mastoid air cells are well aerated. cta head: there is no evidence of arteriovascular malformation in the area of hemorrhage or elsewhere in the brain. no aneurysms and no areas of stenosis are identified . the visualized vessels are patent. atherosclerotic calcifications are noted in the left cavernous internal carotid artery. impression: 1) stable size of hemorrhage in the posterior fossa, likely centered within the cerebellar vermis with effacement of the fourth ventricle. no hydrocephalus. 2) unremarkable cta without evidence of arteriovenous malformation or aneurysms. ct head w/o contrast 4:10 pm ct head without iv contrast: there is a round area of hyperattenuation consistent with hemorrhage (series 2, image 8) measuring 1.6 x 1.7 cm. this focal hemorrhage appears to have the shape of the fourth ventricle but appears to displace the fourth ventricle to the right. the hemorrhage is likely centered within the region of the left cerebellar vermis. there is no significant change from the exam six hours earlier, but this area is new when compared to the previous neck ct. there is no hydrocephalus, although the fourth ventricle appears nearly completely effaced. no other intracranial hemorrhage is identified. there are focal small areas of hypoattenuation within the frontal lobes bilaterally and in the posterior right parietal lobe at the level of the centrum semiovale, consistent with small old infarcts. the paranasal sinuses are well aerated. impression: 1.6 x 1.7 cm hemorrhage likely centered within the region of the left cerebellar vermis, which effaces the fourth ventricle. no significant change from the recently previous head ct. no definite evidence of intraventricular extension or hydrocephalus at this time. cta chest w&w/o c&recons, non-coronary 8:16 pm there is minimal atelectasis at the lung bases, there are no worrisome lung lesions. there is no pericardial or pleural effusion. there is no significant mediastinal lymphadenopathy. the patient is status post median sternotomy. there are multiple calcified granulomas projected over the liver surface which may be diaphragmatic versus hepatic parenchymal. the spleen and adrenal glands appear unremarkable. musculoskeletal: coarse trabecular pattern is seen in the thoracic vertebral bodies and a hemangioma is seen in the mid thoracic spine. cta of the thoracic aorta: the patient is status post ascending aortic repair with ascending aortic graft visualized. the soft tissue at the level of the aortic root including the aortic graft measures 59.7 x 57.6 mm, previously 53.6 x 53.9 mm. the descending thoracic aorta including the true and false lumen at the level of the left inferior pulmonary vein measures 43.0 x 39.4 mm, previously 38.4 x 34.9 mm. the false lumen at this level measures 35.9 x 30.5 mm, previously 35.1 x 28.7 mm. the pseudoaneurysm below the aortic arch at the level of the aortic root surgery measures 30.5 x 13.7 mm, previously 9.2 x 6.3 mm. the descending thoracic aorta at the level of the celiac artery measures 34.9 x 31.2 mm, previously 31.7 x 31.6 mm. the dissection extends from the level of the aortic arch all the way down into the abdominal aorta, the dissection also extends into the celiac axis which is a new finding since the prior examination. the celiac artery fills mostly via the true lumen. the coronary arteries arise from the normal anatomical location and have good perfusion. the dissection extends into the left subclavian artery and there is wide communication between the false and true lumens at the origin of the dissection flap. there is slight differential flow within the false lumen. there is no pulmonary embolism. conclusion: 1. aortic dissection from the level of the aortic root with extension into the left subclavian artery and extension into the descending thoracic aorta, abdominal aorta and the celiac axis. 2. overall interval increase in the size of the soft tissue at the aortic root/site of ascending aortic graft with increased size of the pseudoaneurysm medial to the site of the anastomosis. 3. the extension into the celiac artery is a new finding. ct head w/o contrast 9:56 am ct head w/o contrast reason: eval for extension or hemorrhage or evidence of hydrocephalu medical condition: 68 year old man with midline cerebellar hemorrhage in the setting of coumadin use reason for this examination: eval for extension or hemorrhage or evidence of hydrocephalus given mass effect on 4th on osh ct contraindications for iv contrast: none. indication: 68-year-old man with midline cerebral hemorrhage in the setting of coumadin. assess for interval change. comparison is made to three prior cts, all acquired on , . ct head without contrast: again demonstrated is a rounded focus of increased attenuation in the midline of the posterior fossa between the cerebral hemispheres, consistent with hemorrhage. the size is stable measuring 1.6 x 1.7 cm. size of ventricles is stable. no other foci of intracranial hemorrhage are seen. bony structures and surrounding soft tissue structures are unremarkable. visualized paranasal sinuses are clear. impression: stable midline cerebellar hemorrhage, measuring 1.6 x 1.7 cm. no evidence of interval development of hydrocephalus. portable abdomen 1:17 pm findings: there is no evidence of free intraperitoneal air. there are no dilated small bowel loops or air-fluid levels to suggest small-bowel obstruction. stool and gas is seen in the large bowel. increased density of kidneys are seen bilaterally, raising question of persistent nephrogram from contrast administration on , concerning for renal failure. calcifications are seen in the dome of the liver. the thoracic aorta is increased in diameter, better evaluated on the recent ct. impression: 1. no evidence of a bowel obstruction. 2. persistent nephrograms bilaterally, concerning for renal failure. brief hospital course: mr. is a very pleasant 68 year old gentleman with history of aortic dissection s/p arch repair and fem-fem bypass, multiple embolic strokes felt to be due to the surgery, with no residual deficits per the patient prior to this admission, also hypertension, hyperlipidemia, who presented with 3 days of nausea, vomiting, and gait ataxia. he was found to have an 18 mm hemorrhage in the cerebellar vermis with some mass effect on the 4th ventricle. on exam his mental status testing was intact, and he was without focal weakness; he was clumsy with rapid alternating movements bilaterally (l > r), and most significantly his gait was ataxic. the most likely etiology of his hemorrhage is due to the recent initiation of coumadin and hypertension, however an underlying mass lesion could not be ruled out. follow up mri should take place as detailed below. 1) cerebellar hemorrhage- the patient was symptomatic for 3 days prior to presentation, and likely had already reached the peak of edema, however there was evidenc by ct for pressure on the 4th ventricle. neurosurgery was consulted on the arrival and followed him throughout this admission. he did not require surgical decompression or other surgical intervention. his inr was reversed with profiline and vitamin k. given the location in the posterior fossa and risk of brain stem compression, he was admitted to the neuro-icu for observation and started on mannitol diuresis. repeat head ct revealed stable size of hemorrhage without significant mass effect. his blood pressure was tightly managed on his home regimen in combination with a labetalol gtt. goal map < 130. he was later changed to his home regimen alone with excellent blood pressure regulation. his neurologic examination remained stable in combination with stable head ct. his gait ataxia persists necessitating acute rehab placement. follow up mri/mra +/- gadolinium should take place in a few weeks to further evaluate the site of hemorrhage for possible underlying mass lesion. his cochlear implant and clip for his vitreous hemorrhage will need to be cleared for this mr examination. the order was placed in , need to be scheduled by the patient once he is available for the study. call ( for appointment. 2) aortic dissection- cardiac surgery was consulted for possible widened mediastinum by admission chest xray. cta revealed 1cm worsening of pseudoaneurysm at the junction of the ascending aorta with the graft. this was considered to be an expected finding with aortic grafts and no further intervention was warranted. he should follow up with his cardiac surgeon dr. in 3 months following discharge. he was continued on dyazide, altace, and norvasc and metoprolol tid for tight bp control. 3) femoral bypass graft thrombus- coumadin was held on admission given hemorrhage. vascular surgery was consulted. the patient has an appointment to see dr. (vascular surgery) at in 2 weeks for further evaluation. dr. would like to be contact for further discussion should dr. feel coumadin therapy is warranted. 4) nausea/ pt complained of occasional nausea/vomiting after meals. this resolved with prn antiemetics. he lacked any abdominal pain or other signs of bowel ischemia. his abdominal xray was without signs of bowel obstruction. aggressive bowel regimen relieved his symptoms significantly. further evaluation may continue at rehab should symptoms persist. 5) renal- stable renal function. urine osmolality was followed while on mannitol. persistent nephrograms on abdominial xray likely incidental finding, but could related to altered vascular anatomy s/p aortic graft. further follow up to take place with vascular and cardiac surgery. medications on admission: metoprolol 75 tid asa 81 mg qd colace norvasc 10 mg qd zocor 40 mg qd dyazide 37.5-25 qd altace 5 mg qd coumadin 2.5 mg qd (started for clot in bypass) discharge medications: 1. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 2. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain, t > 100.4. 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 5. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 6. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 7. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed. 8. ramipril 5 mg capsule sig: one (1) capsule po daily (daily). 9. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 10. triamterene-hydrochlorothiazid 37.5-25 mg capsule sig: one (1) cap po daily (daily). 11. ondansetron hcl (pf) 4 mg/2 ml solution sig: one (1) injection q8h (every 8 hours) as needed for nausea. discharge disposition: extended care facility: blueberry skilled nursin facility discharge diagnosis: cerebellar hemorrhage discharge condition: stable. persistent cerebellar gait ataxia. discharge instructions: you were admitted for a cerebellar hemorrhage. this was likely related to coumadin use. you should have an mri as an outpatient to evaluate this area in a few weeks. do not take coumadin or aspirin until you are seen by dr. in vascular surgery, if dr. would like to start coumadin he should confer with dr. (neurology) prior to doing so. please continue to take all medications only as listed in this discharge summary. call your doctor or 911 for chest pain, shortness of breath, worsening dizziness, weakness, numbness, tingling or any other concerning symptoms. followup instructions: you have a follow up appointment with dr. at neurology on at 1:30pm. please obtain a referral from your primary care doctor. please call to update your patient information. you have an appointment to see your vascular surgeon , md phone: date/time: 9:00 in the on suite 5c. please call for a follow up appointment to see your cardiac surgeon dr. regarding your aortic graft in 3 months. md, procedure: arterial catheterization diagnoses: unspecified essential hypertension thoracic aneurysm without mention of rupture intracerebral hemorrhage other and unspecified hyperlipidemia surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other complications due to other vascular device, implant, and graft long-term (current) use of anticoagulants personal history of venous thrombosis and embolism anticoagulants causing adverse effects in therapeutic use renal failure, unspecified 

Answer: The patient is high likely exposed to