Cerebral air embolism is an uncommon, but high morbidity and mortality, event that can be complicated from many medical procedures, including cardiac surgery, venous and arterial access, laparoscopic surgery, or from trauma. Transthoracic needle biopsy is also another diagnostic intervention that can causing this event. Even though risk of air emboli is low, 0.2-0.4%, but its mortality rate is as high as 26%. Clinical presentation can mimic other stroke syndromes but had different mainstay of treatment, not antiplatelet but oxygen therapy. We report case a 64 years old male suddenly develop confusion and left hemiparesis after doing transthoracic needle lung biopsy. Computer scan (CT) brain imaging show air in the brain parenchyma and along sulcus and gyrus. Oxygen therapy was started as soon as he was diagnosed. Transthoracic echocardiogram with agitated saline was done to evaluate other causes of stroke. This uncommon causes of stroke should always be kept in mind when sudden onset of neurological symptoms occurs in patient who had been through procedure at risk of this complications. CT scan is imaging technique of choice, allowing to detect air bubble, more easily than magnetic resonance imaging (MRI).