Cerebrovascular imaging of carotid embolization: Amaurosis fugax and transient ischemic attack in motion.

We describe a 65-year-old male ophthalmologist who experienced a brief episode of transient monocular vision loss in his left eye, characterized as a "gray-out" lasting a few seconds. Utilizing his medical expertise, the patient recorded the blood flow in his ophthalmic artery, capturing a rare real-time visualization of embolus migration from the central to peripheral regions. The embolism resolved spontaneously, restoring normal vision. Duplex ultrasound revealed high-grade stenosis in the proximal left internal carotid artery, with a peak systolic velocity of 421 cm/s and an end-diastolic velocity of 188 cm/s, consistent with over 90% stenosis. A computed tomography angiogram confirmed the presence of an ulcerated plaque, attributing the vision loss to emboli originating from the carotid artery. Because of the critical stenosis and risk of further cerebrovascular events, a semiurgent left carotid endarterectomy was performed under regional anesthesia. The procedure was completed without complications, and the patient's vision remained normal postoperatively. This case highlights the unique real-time documentation of an embolic event in an ophthalmologist who recognized the pathophysiology, emphasizing the importance of timely diagnosis and intervention, particularly carotid endarterectomy, in preventing stroke and irreversible vision loss in patients with high-grade internal carotid artery stenosis.