This report describes a complication of symptoms consistent with transient ischemic attack following administration of physician-compounded foam sclerotherapy created with room air. After intravenous administration of 8 cc of foam sclerosant prepared with room air and polidocanol using the Tessari method, an otherwise healthy man experienced transient neurologic changes. Immediately following injection of foam, a dense hemiplegia consistent with interruption of the middle cerebral arterial circulation was observed. The patient’s symptoms resolved completely over approximately 30 min with interventions including Trendelenburg positioning and supplemental oxygen via nasal cannula. PCP foam sclerotherapy with room air administered in typical concentrations, preparations, and volumes may result in severe neurologic events in otherwise healthy individuals. Continued investigation into the potential role of product, gas, volume and technique to identify optimal approaches may further refine the consistency and safety of foam sclerotherapy.