A 70-year-old male with a history of smoking and high cholesterol complains of episodes of transient blindness in his right eye, describing it as a "curtain coming down" over his vision. These episodes last only a couple of minutes and then resolve spontaneously. What is the likely diagnosis, and what is the recommended management?
This patient is describing symptoms consistent with amaurosis fugax, which is a temporary loss of vision due to decreased blood flow to the eye, typically from an embolus. Given his history of atherosclerosis risk factors, the source is likely carotid artery disease. The patient should be evaluated with carotid duplex ultrasound to assess for carotid stenosis. Aspirin therapy should be started, and depending on the severity of stenosis, he may require a carotid endarterectomy or stenting.