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: left sided weakness major surgical or invasive procedure: pulmonary angiography transesophageal echocardiogram history of present illness: mr. is a 60 year-old right-handed man with no significant pmh who presents with acute onset speech difficulties and left sided weakness. according to his son and daughter-in-law, who provide the history, he was last known well around 9:30 or 10 pm last night prior to going to sleep. his wife noted him moving in bed around between 12:30 and 1 am and then reportedly tried to wake up him for about a half hour, but he was not speaking and she believed he was just sleeping. when the lack of speech persisted, and she believed his left side was weak, she awoke the rest of the family, who then proceeded to call 911. when they first found him, he was described as unconscious because his eyes were open, but he was not saying anything. he was also noted to not be able to move his left side. he was brought to osh, where it was noted that he was out of the window for tpa as his last known well time was 9:30 pm last night and was then transferred to for further management. ros: unable to obtain due to expressive aphasia. per family, he was not experiencing any symptoms prior to acute events of this evening. past medical history: none b12 deficiency - found during hospitalization hyperhomocysteinemia - found during hospitalization social history: he lives in and has been visiting his family here. he smokes 1 pack of cigarettes every 2-3 days and has done so for about 30 years. occasional alcohol use. no known illicit drug use. family history: no history of strokes physical exam: t: 97.5 p: 60 r: 14 bp: 102/63 sao2: 100% on 4l nc per ed- lue systolic bp 70s, rue systolic bp 140s general: awake, lethargic heent: nc/at, no scleral icterus noted, dry mucus membranes, no lesions noted in oropharynx neck: supple, no carotid bruits appreciated pulmonary: lungs cta bilaterally cardiac: rrr, s1s2 abdomen: soft, nondistended, +bs extremities: warm, well-perfused mental status: initially awake, but very lethargic. level of alertness improved while in ed though remained lethargic. once expressive aphasia improved, he was able to say his name and the date correctly. language: in addition to an expressive aphasia, there also seemed to be an english language barrier, requiring his daughter-in-law to occasionally translate. at baseline, she says that he is able to understand but not always speak english. speech somewhat slurred and difficult to understand. initially with dense expressive aphasia, but later was able to name objects including watch, thumb, chair and cactus and was able to repeat, though had to be asked multiple times in both is native language and english. comprehension appeared intact for simple midline and appendicular commands, but unclear if there are defecits in comprehension of more complex commands with possible element of a receptive aphasia as sometimes he would be asked to do one thing and he would do another. on repeat testing while in ed, he was able to read sentences. cranial nerves: i: olfaction not tested. ii: perrl 4 to 2mm and brisk. initially appeared to be dense left hemianopia on visual field testing, but later on partial hemianopia noted iii, iv, vi: primary gaze in midline. initially unable to cross midline to look left, but eye movements improving over time, though still not able to fully look left v: appears to be intact to pinprick based on grimmace vii: l lower facial droop viii: unable to assess ix, x: palate elevates symmetrically : scm appears intact xii: tongue protrudes in midline motor: normal bulk. increased tone noted on left, upper greater than lower extremity. pronator drift on right. on strength testing, he was initially unable to demonstrate any antigravity strength on left; however, later he had at least 4-/5 strength of upper extremity extensors and lower extremity flexors. formal strength testing complicated by likely language barrier and aphasia. sensory: initially pinprick sensation appeared diminshed on left with light tough grossly intact. later, he noticed pinprick more (based on his grimmace response). he did extinguish left to dss. dtrs: tri pat ach l 2 2 2 2 1 r 2 2 2 2 1 plantar response was flexor on right and extensor on left. coordination: f-n intact on right and ataxia does not appear out of proportion to weakness on left. gait: deferred out of concern for falling with l hemiparesis on discharge general: awake, lethargic heent: nc/at, no scleral icterus noted, dry mucus membranes, no lesions noted in oropharynx neck: supple, no carotid bruits appreciated pulmonary: lungs cta bilaterally cardiac: rrr, s1s2 abdomen: soft, nondistended, +bs extremities: warm, well-perfused neuro ms: alert, attentive, language is fluent w/ no paraphasias, normal repetition, comprehension intact; no neglect cn: i: olfaction not tested. ii: perrl 4 to 2mm and brisk. initially appeared to be dense left hemianopia on visual field testing, but later on partial hemianopia noted iii, iv, vi: primary gaze in midline. initially unable to cross midline to look left, but eye movements improving over time, though still not able to fully look left v: appears to be intact to pinprick based on grimmace vii: mild flattening of the l nl fold viii: unable to assess ix, x: palate elevates symmetrically : scm appears intact xii: tongue protrudes in midline motor: delayed excursion of the left deltoid; otherwise there is full strength sensation: intact throughout reflexes: normal and symmetric with downgoing toes coordination: no dysmetria on fnf gait: normal stride and gait pertinent results: ct 1. small occlusive thrombus in the right m1 segment and a large right mca distribution established infarction involving the right frontal, parietal and temporal lobes. 2. small occlusive thrombus in the left proximal subclavian artery proximal to vertebral origin. 2. small low-density thyroid nodules can be better evaluated with ultrasound if not performed earlier. 3. minor emphysematous changes in the visualized upper lobes. mri 1. established infarct in the right caudate, putamen, insular cortex and temporal lobe. since the recent cta study, there has been reperfusion in the right frontal and temporal lobes. the right m1 segment is recanalized. irregularity in the inferior division of right mca could represent thrombus or atherosclerotic disease. 2. occlusive thrombus in the left subclavian artery proximal to the left vertebral artery origin. 3. small focus of hypointensity in the right sylvian fissure may represent a vessel flow rather than hemorrhage. tee: no intracardiac source of embolism seen. no asd or pfo with administration of agitated saline. tte: no pfo, asd, or cardiac source of embolism seen. normal global and regional biventricular systolic function. pulmonary angiogram - final report pending hga1c 5.9 flp: chol 162 tg 174 hdl 29 ldl 98 homocysteine 26.2 b12 109 brief hospital course: r mca infarct mr. was admitted to the neurology stroke service after he experienced sudden onset of left-sided weakness and reportedly had difficulty speaking. he was called as a code stroke and initially had an nihss of 21 which improved to 11 in the ed. he was outside of the window for ivtpa and ia tpa was deferred given improvement in his exam. his exam initially was consistent with a left-sided hemiplegia in an umn pattern however his motor deficits resolved during hospitalization. his imaging initially showed a right m1 mca thrombus which recanalized on his f/u mra. his mri showed infarcts in the right caudate, putamen, and insular cortex. he had a cta which showed a rul pulmonary 8 mm hypodensity that was thought to be an avm. pulmonary was consulted and felt that this could be related to his stroke and ir performed a pulmonary angiogram on , however this failed to demonstrate an avm. his labs showed a hga1c of 5.9, his lipid panel was normal. his b12 was low and he was started on 7 days of 1000 mcg b12 injections. he had an elevated homocysteine. he was started on a 325 mg tab of aspirin daily and simvistatin 10 mg daily and was seen by pt/ot and felt that he was safe for discharge home without services. he will get a follow-up ct chest done prior to seeing the pulmonologist in the outpatient clinic. he had several labs drawn prior to discharge including: , anticardiolipin. he will f/u with dr. and his pcp. medications on admission: none discharge medications: 1. cyanocobalamin (vitamin b-12) 1,000 mcg/ml solution sig: one (1) ml injection daily (daily) as needed for 07 days for 2 days. disp:*1 ml* refills:*0* 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: home with service discharge diagnosis: right middle cerebral infarction right upper lobe mass discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the neurology service after you had sudden onset of left sided weakness and some difficulty speaking. your initial nih stroke scale was 21, however this improved to 11 while in the ed. you were out of the window for ivtpa, and intravascular tpa and clot retrieval was deferred given improvement in symptoms. your exam continued to improve during your hospital stay and you had no testable weakness or language deficits by time of discharge. your mri showed an infarct in the right mca territory with infarction of the caudate, putamen, and insular cortex. initially a thrombus was seen in the m1 segment of the right mca, but on follow-up imaging there was recanalization of the vessel. there was demonstration of a right upper lobe possible avm seen on cta of the chest. pulmonary angiography did not see an avm. you had a transthoracic echo and a transesophageal echo, neither of which showed an intracardiac source. your labs revealed that you had a low b12 and you were started on b12 injections. 1. you will need to follow-up in clinic with dr. 2. you will need to follow-up with your primary care physician 2-4 weeks. 3. you were started on b12 injections; you need to take 2 more injections; once daily 4. you will need to get a follow up chest ct with contrast prior to seeing the pulmonary doctors. one was scheduled for . 5. , and antiphospholipid panel was sent and should be followed up on discharge. followup instructions: provider: function lab phone: date/time: 3:40 provider: ,interpret w/lab no check-in intepretation billing date/time: 4:00 provider: . / dr. phone: date/time: 4:00 monday @ 2pm with dr. - at 8 procedure: diagnostic ultrasound of heart arteriography of pulmonary arteries diagnoses: tobacco use disorder other b-complex deficiencies cerebral embolism with cerebral infarction embolism and thrombosis of other specified artery aphasia swelling, mass, or lump in chest hemiplegia, unspecified, affecting nondominant side homonymous bilateral field defects disturbances of sulphur-bearing amino-acid metabolism 

Answer: The patient is high likely exposed to