<s>[INST] I am a 73 yr old man, 62 kilos with high blood pressure for these last 20 yrs but it is successfully being treated. I do sports, don t smoke and drink daily a small glass of wine. My mom died at 93 due to leucemia and father at 88 due to a massive stroke (his family was prone to strokes). I just had my yearly physical exam (ultra-sound of internal organs, blood profile, etc and all was normal. I take 100 mg of aspirin daily, Diovan 80 mg, Natrilix 1.5 mg, Norvasc 2.5 mg, Lipitor 5 mg on a daily basis. On 17 January I had a canine tooth extracted - a difficult extraction lasting one hour including opening up of the gum to see if it was possible to save the decayed tooth. Today, 30/01 the wound is almost healed and I ll see the dentist about an implant. However yesterday a.m. I think I had a transient ischemic attack experiencing great difficulty in articulating (speaking). It lasted about 30 minutes and now I feel fine. This p.m. I ll see my family doctor. Could this TIA be related to the stress of the extraction and periodontal work although the dentist monitored my blood pressure during this operation? I ve been living in Kunming, China (1800 metres altitude) for the last 21 yrs and in Cameron Highlands (Malaysia) for the last 3 months. Currently I am in Hong Kong since 9 January. Thanks, Jean-Noël Posner [/INST] Hi, First of all, before a tooth extraction, you should have taken an antibiotic, because the bacteria in your mouth enter the bloodstream cause septicemia and the bacteria can proliferate on atherosclerosis plaques causing blood clots and transient ischemic attacks. You do not need to increase the dose of Aspirin you take. The living on a high altitude place cannot directly cause TIA. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Dr/Mustafa, Neurologist </s>