Background: Cerebrovascular diseases are very common in hemodialysis (HD) patients. Silent brain infarction (SBI) has not been thoroughly investigated in HD patients although it may be a significant risk factor for cerebrovascular diseases. Methods: forty Egyptian CRF patients (of both sexes 15 females and 25 males with mean age 55.23 +/- 6.38) maintained on HD, and twenty Egyptian hypertensive patients (of both sexes 8 females and 12 males with mean age 55.85 +/- 7.597) with no renal impairment were included in the study. Both patients and controls had no history of stroke, TIA, or dementia. MRI of the brain was performed to all patients and controls. Patients were divided into group with SBI and group without BI. Results: showed the following (1) SBI was detected in 40% of patients and in only 5% of controls. (2) Patients with SBI were older and had higher smoking prevalence than those without BI. (3)There was a highly significant result between the two groups as regard duration of HD. (4)BP was higher (highly significant P. value < 0.001) in SBI group than group without BI. (5) More than 56% of patients with SBI had increased IMT compared with 12.5% in patients without BI.Conclusion: Renal dysfunction has a higher prediction for ischemic cerebrovascular events especially if associated with risk factors like old age (above 55 year), smoking, hypertension, long duration on hemo-dialysis (more than 3 year),and increased intima/media thickness. So, careful, meticulous screening and investigation (including doing MRI brain) in CRF patients on HD, especially those at higher risk, for cerebrovascular stroke are recommended.